Control or Reversal of Atherosclerosis Through Therapy of Lipid Disorders

Abstract

Until recently, experiments designed to test the hypothesis that human atherosclerotic lesions can be modified by reducing levels of “atherogenic” plasma lipoproteins have relied on indirect endpoints (cardiac death; signs or symptoms of ischemic vascular disease). Large numbers of persons must be enrolled in such trials and the hypolipidemic treatment must therefore be simple in application. Experience has shown that only small reductions of the level of cholesterol-rich lipoproteins (usually evaluated by changes in serum cholesterol) can be obtained in such studies. Furthermore, in order to achieve a requisite sample size, it has not proved feasible to limit enrollment to persons whose risk of experiencing the defined endpoint is very much higher than that of the population at large. The results of such studies have been equivocal, although in the main they provide some encouragement that intervention with diet or drugs may modify the course of atherosclerotic disease. In the next few months, the results of the most extensive such trial will be published—the Lipid Research Clinics Coronary Primary Prevention Trial¹.