• Hyperlipidemias
• Epidemiology
• Treatment Outcome

The legacy effect refers to the long-lasting benefits of an early intensive treatment that persist even after the cessation of the intervention.1–3 In the prevention setting, it means that a timely control of risk factors leads to more favourable long-term outcomes. One of the first pieces of evidence for this phenomenon comes from the post-trial follow-up study of the United Kingdom Prospective Diabetes Study (UKPDS) trial. In the UKPDS, patients with newly diagnosed type 2 diabetes were randomised to intensive versus conventional glycaemic control. In the intensive glycaemic control group, there was a 25% decrease in microvascular complications over the 10-year period of the active trial. Reports at 10 years after the end of the trial confirmed a persistent treatment effect, despite mean glycated haemoglobin values becoming no different between study groups by 1 year after the trial end, and then decreasing progressively over time in both groups with increasing use of other glucose-lowering medications.1 The biological explanation behind this phenomenon has been attributed to ‘metabolic memory’, which clinically translates to the importance of adequate and early risk factor control.

Sever and colleagues4 present the 20-year follow-up results of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). This study was a randomised controlled trial recruiting ~19 000 hypertensive patients with no history of coronary heart disease and at least three other cardiovascular risk factors. Following a factorial design, a subset of ~10 000 patients with total …