In intervention trials it was without exception possible to influence the development of atherosclerosis by a reduction of the LDL-cholesterol and an increase in HDL-cholesterol and to reduce complications like myocardial infarction, sudden cardiac death, angina or heart failure. Changes of lifestyle can be effective, but are rarely accepted and are difficult to communicate. That is the reason why the pharmacological lipid therapy of arteriosclerotic cardiovascular disease has been successfully propagated, so that financial limits are reached and health economic problems have arisen. In secondary prevention lipid therapy is recognized as part of the standard therapy because of its efficiency similar to other established therapies. Yet, for primary prevention it is a principle question if it should be covered by health insurances. Basis for a medically effective application, but also for a cost-effective reimbursement might be the cardiovascular risk. Algorithms derived from large epidemiological studies allow simple calculations of the individual global risk. Even more informative might be an estimate of the expected benefit, which includes the age-specific absolute risk reduction and might consider the individual life expectancy.
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