Serum
cholesterol has long been recognized as an important risk factor for the development and progression of atherosclerotic
vascular disease. For more than 30 years, improved outcomes with
lipid lowering have been demonstrated. As a result of these data, the National Heart, Lung, and Blood Institute (NHLBI) convened the National
Cholesterol Education Program-Adult Treatment Panel I (NCEP
ATP I). This panel and similar ones around the world have served to set the standards for
lipid lowering in clinical practice. Subsequent revisions of these standards (NCEP
ATP II and III) have led to greater focus being placed on
LDL, and targets for lowering
LDL levels being based on patients' risk of subsequent
coronary disease events. Since the publication of the NCEP
ATP III guidelines, several large-scale clinical trials of
cholesterol lowering have been conducted, the findings of which have the potential to impact on clinical practice standards. In this article we focus on current guidelines for
lipid-lowering
therapy, review the results and implications of important completed clinical trials, and consider the utility of additional targets for preventive
therapy, such as
C-reactive protein and HDL. We also consider the prospects for treatments in development and future goals.