Abstract
As of the early 1980s, despite the wealth of evidence from experimental animal models, the extensive epidemiologic evidence, the powerful genetic evidence, and the strongly suggestive clinical intervention trial results, most clinicians still remained unpersuaded regarding the relevance of the lipid hypothesis. What was needed was a well-designed, large-scale, long-term, double-blind study demonstrating a statistically significant impact of treatment on coronary heart disease events. The National Institutes of Health (NIH) had laid the groundwork for such a study as early as 1970, but the study was not completed and the results published until 1984. This study, the Coronary Primary Prevention Trial, showed that treatment with a bile acid binding resin reduced major coronary events in hypercholesterolemic men by 19%, with a P value of 0.05. The NIH followed this up with a national Consensus Development Conference on Lowering Blood Cholesterol to Prevent Heart Disease. For the first time, the NIH now went on record advocating screening for hypercholesterolemia and urging aggressive treatment for those at high risk. The Institute initiated a national cooperative program to that end, the National Cholesterol Education Program. For the first time, preventing coronary heart disease became a national public health goal.
Highlights
As of the early 1980s, despite the wealth of evidence from experimental animal models, the extensive epidemiologic evidence, the powerful genetic evidence, and the strongly suggestive clinical intervention trial results, most clinicians still remained unpersuaded regarding the relevance of the lipid hypothesis
Lees, had just published a highly influential series of reviews in the New England Journal of Medicine [4,5,6]. They proposed a classification of abnormalities of serum lipids based on total cholesterol and triglyceride levels plus the lipoprotein pattern revealed by paper chromatography
It was proposed that each of the Lipid Research Clinics would participate in a multicenter trial to definitively test the “lipid hypothesis.”
Summary
The keystone in the arch of evidence linking blood cholesterol to heart disease In June 1970, Theodore Cooper, Director of the National Heart and Lung Institute, asked Donald S. Lees, had just published a highly influential series of reviews in the New England Journal of Medicine [4,5,6] They proposed a classification of abnormalities of serum lipids based on total cholesterol and triglyceride levels plus the lipoprotein pattern revealed by paper chromatography. Possibly even more so, the Panel was asked, “Do you believe the evidence is sufficient to warrant the detection of and some form of individual treatment of hyperlipidemia?” Of the 21 experts, 20 answered yes They recognized that the evidence that such treatment would reduce heart attack rates, and by how much, was still limited. Others, including Levy, felt strongly that a definitive intervention trial should be an integral part of the package and get a very high priority As it turned out, the Lipid Research Clinics program was approved and funded with almost no opposition. It was proposed that each of the Lipid Research Clinics would participate in a multicenter trial to definitively test the “lipid hypothesis.”
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