OPINION Can we dramatically reduce the incidence of coronary heart disease?

Thrombotic events caused by atherosclerosis are by far the most common cause of death in the world. Advances in treatment have prolonged the life of patients with atherosclerotic disease, but treating individuals with clinically manifest disease will not result in a cure, and will not prevent the majority of such events. This paper explores the possibility that early implementation of a drug-based approach to the prevention of atherosclerosis and atherothrombotic events could dramatically reduce the footprint of this disease. Specifically, we consider the potential impact on atherothrombotic events of a population-based, pharmacological approach to lowering serum LDL-cholesterol levels in asymptomatic adults aged 35-50 years. We also consider the feasibility and basic design considerations for a clinical trial to assess the validity of this public health and primary prevention approach.