How best to combat the enemies? Lipid lowering

The evidence linking elevated plasma low-density lipoprotein cholesterol to atherosclerosis and its clinical consequences is overwhelming. Similarly, there is now compelling evidence that the risk of these complications can be reduced by lipid-lowering therapies. Research reported during the past few years has helped to clarify the apparent paradox of substantial reductions in the risk for cardiovascular events in the presence of minor changes in the extent of coronary artery stenosis. It is clear that lipid reduction results in favourable changes in plaque morphology and composition, reflecting a reduction in the inflammatory content and an increase in the smooth muscle content that Favour stability. In addition, changes in endothelial function, platelet adhesiveness and theology all potentially play a role in the beneficial effects of lipid lowering. (C) 2002 The European Society of Cardiology.