Primary prevention of coronary heart disease - What has WOSCOPS told us and what questions remain?

Coronary heart disease remains the major cause of death and morbidity in developed countries. As a consequence, its prevention constitutes a significant public health challenge. In recent times, our understanding of this disease process has expanded and many of the factors that influence its expression have been elucidated. In addition, a number of trials of diet and lipid-lowering drugs have been performed in an effort to tackle this problem. These studies demonstrate that when lipid levels are favourably altered, cardiovascular events are reduced without adverse effect. The rate at which event outcomes diverge between treated and untreated patients depends on the degree of atherosclerosis manifestation prior to treatment and the aggressiveness of the lipid altering strategy. Nonetheless, to date, the residual risk of cardiovascular events is still unacceptably high despite even the most potent lipid-lowering treatments used in these trials. In order to minimise the risk of future events, earlier intervention and a greater change in LDL and HDL cholesterol levels are needed in conjunction with other risk factor modifications.