Preventing myocardial infarction: cholestyramine (Questran) and other hypolipidemics.

For decades the association between serum cholesterol and atherosclerotic heart disease has been recognized; the higher an individual's serum cholesterol concentration, the greater the risk of myocardial infarction and other manifestations of coronary artery disease. Many of the hypolipidemics (drugs that reduce levels of lipids in the blood) have been available for more than 10 years, but only last year was one of these agents, cholestyramine (Questran), approved for use in the prevention of coronary heart disease. The purposes of this article are to describe the events that led to the approval of this indication for cholestyramine (but not for the other hypolipidemics), to explore the factors that primary health care practitioners should consider in the management of hypercholesterolemia and to anticipate future developments in hypolipidemic therapy.