Current pharmacologic treatment of elevated serum cholesterol.

A basic difference between dietary and drug therapy of hypercholesterolemia is that dietary therapy can be used as part of a population strategy, whereas the decision to use drugs is always made on an individual basis. In each case, the decision to treat must be based on the assumption that more good than harm is caused to the patient. This is a difficult situation for the physician. As long as there is no easy way of assessing the state and rate of progression of coronary lesions, the physician must treat the patient on statistical grounds only, i.e., rely on the results of studies showing that lowering serum cholesterol significantly decreases the risk of coronary events. Such evidence has recently been strengthened, which increases motivation for both physician and patients. The current general opinion is that drug therapy must be generally confined to those at high risk, i.e., patients with severe hypercholesterolemia. For individuals with moderately elevated serum cholesterol levels, dietary advice and correction of other risk factors should be adequate.