Abstract
Cholesterol-lowering and its relationship to acute coronary syndromes is the focus of this article. The pathophysiology of plaque formation and plaque rupture are briefly discussed as is the current thinking on the impact of cholesterol-lowering on these processes. How cholesterol affects endothelial function and plaque passivation (the complex process of stabilizing the active plaque at risk of rupture) are key elements. A few hallmark clinical trials and their impact on coronary heart disease (CHD) clinical event rates are discussed as is the impact of statin therapy on CHD management. A brief description of the National Cholesterol Education Program and its recommendations for primary and secondary prevention are included.