Using Computer-Based Decision Support to Close the “Know–Do” Gap in Lipid-Lowering Therapy

strange paradox haunts our attempts to prevent ischemic heart disease. Medicine has addressed the relation between serum lipids and atherosclerosis through a series of scientific triumphs. First, epidemiology demonstrated the association be- tween abnormal cholesterol levels and coronary artery disease. Then, physiology and biochemistry elucidated the pivotal role of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reduc- tase in the synthesis of lipoproteins. Next, pharmacology led to the development of new medications to target that enzyme without the often-unbearable side effects of earlier drugs. And finally, clinical researchers enrolled tens of thousands of patients at hundreds of centers worldwide to prove the efficacy of these treatments and help guide their use. Taken together, these steps represent one of the finest examples of the application of science to understand and ameliorate human disease. Article p 371