Abstract
Background: As part of the National Cholesterol Education Program (NCEP) two expert panel reports (1988, 1993) recommend serum cholesterol measurements in all adults aged 20 years and older and cholesterol-lowering treatment for those with abnormal levels.
Methods: All major drug intervention trials for primary prevention of coronary heart disease were reviewed. Similarly, selected studies on risks of dyslipidemia and benefit of therapy for the elderly and for women without coronary heart disease were analyzed. These studies were evaluated to test the soundness of the NCEP panel's recommendations.
Results and Conclusions: Five major randomized drug intervention trials for primary prevention of coronary heart disease showed that cholestyramine, gemfibrozil, clofibrate, and pravastatin can reduce the rate of nonfatal myocardial infarctions in middle-aged men. All-cause and ischemic heart disease mortality were increased by clofibrate and unaffected by the other three drugs. Extrapolation of these findings to women and older and younger men is unwarranted because there is no evidence that either diet or drugs provide primary protection from coronary heart disease in these groups. It is uncertain whether dyslipidemia is a risk factor for coronary heart disease in the elderly. The annual cost of drugs for full implementation of the panel's recommendations ranges from $6 billion to $11.5 billion and an additional $13 billion will be required for initial screening, classifying, and monitoring serum cholesterol levels. Potential adverse consequences of a national program include possible risks from low cholesterol levels, drug side-effects, and disease labeling.
