Lipids and vascular disease: what we do and do not know

The demonstration that lowering the level of low-density Lipoproteins (LDL) in plasma substantially reduces the incidence of death and symptomatic coronary disease may be the most important advance ever in cardiovascular therapeutics. Indeed it has been perceived as so dramatic that it could give rise to the view that the only problem now is application. That would be unfortunate because critical questions remain unanswered. Amongst these are whether all patients with coronary disease will benefit from LDL lowering and what should be the target of such therapy. Moreover, it remains uncertain whether other approaches such as lowering triglycerides should also be strongly supported. More fundamentally, inadequacies in what has become the traditional approach to characterize risk are becoming increasingly evident. This paper will outline issues that remain unresolved and suggest clinical approaches to deal with them. (C) 1999 Elsevier Science B.V. All rights reserved.