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Hypercholesterolaemia

Importance as a Coronary Heart Disease Risk Factor and Rationale for Treatment

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Summary

Evidence for reducing the incidence of coronary heart disease (CHD) by a reduction in total cholesterol and an increase in HDL-cholesterol has been assessed by reviewing ‘natural experiments’ and drug trials, as well as non-pharmaceutical intervention. From experience gained during the Second World War, it seems as if the lag-time, i.e. the interval between induced changes in causally related risk factors and an observable decrease in the incidence of CHD, is approximately a couple of years. This was confirmed in the Helsinki gemfibrozil trial as well as in the Oslo intervention study.

So far, all the trials have included mainly middle-aged men. The decrease in CHD incidence in these trials corresponds with what would have been expected from the cholesterol changes. None of the drug trials published so far have been able to show any impact on total mortality figures, but the excessive mortality rate from non-cardiovascular causes observed in the intervention groups was due to an increase in violent deaths. Cancer deaths were not excessive in the intervention groups. Good data on the effect of CHD risk factor intervention in women and the elderly are still required.

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Authors and Affiliations

  1. Department of Epidemiology and Medical Statistics, Nordic School of Public Health, Gothenburg, Sweden

    Dag S. Thelle

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  1. Dag S. Thelle
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Thelle, D.S. Hypercholesterolaemia. Drug Invest 2 (Suppl 2), 1–8 (1990). https://doi.org/10.1007/BF03258188

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