LIPIDS AND SECONDARY PREVENTION OF ISCHAEMIC HEART DISEASE

Ischaemic heart disease remains the major cause of death for men and women in the developed world and, with stroke, is a key area for health promotion in The Health of the Nation.1 The importance of primary prevention (reducing risk in people with no evidence of disease) is highlighted by the fact that about a quarter of new cases of ischaemic heart disease present as sudden death.2 Secondary prevention (reducing risk in people with evidence of disease) should be approached with the same vigour as primary prevention because morbidity and mortality from ischaemic heart disease have considerable social and financial implications for individuals as well as communities. Measures that improve survival after myocardial infarction include treatment with thrombolytic agents, aspirin, and s adrenergic blockers, and stopping smoking. Lowering serum lipid concentrations in patients with ischaemic heart disease and hypercholesterolaemia has been shown to reduce the risk of subsequent cardiovascular death. Concerns have been raised that the cardiovascular benefits of lowering cholesterol concentrations might be outweighed by the increased risk of other causes of death. However, the Scandinavian simvastatin survival study (4S), a large randomised, placebo controlled trial of simvastatin in patients with ischaemic heart disease and total cholesterol concentrations of 5.5-8.0 mmol/l, showed significant improvements in mortality from ischaemic heart disease with no evidence of increased mortality from non-cardiovascular causes …