These studies reinforce the message that lipid management for secondary prevention should be a high priority, regardless of whether the patient is female or male, young or old. In the absence of multiple cardiac risk factors, statin therapy is far less cost-effective when used for primary prevention, particularly if high-risk patients receive other preventive therapies, such as aspirin (10). As we make progress in identifying effective new strategies for the prevention of coronary disease, these conclusions may need modification. For example, imaging techniques, including carotid ultrasonography, ultrafast cardiac computed tomography, and magnetic resonance imaging, are being assessed for their ability to detect atherosclerosis. If they are successful, they will help direct preventive efforts toward the patients who are most likely to benefit. Trials are evaluatingthe effectiveness of alternative preventive interventions, such as folate supplementation, that may reduce risk independently of cholesterol-lowering drugs. If these interventions prove to be cost-effective, the role of statins will change. Another important consideration is the changing costs of statins. As both studies show, the cost-effectiveness of therapy depends directly on the prices of the medications. If, as expected, patent expiration leads to a decrease in statin prices, the cost-effectiveness of these drugs in all patient populations will improve. For all of these reasons, strategies for the prevention of coronary disease will continue to evolve. For the time being, though, prudent—and cost-effective—practice means continuing to pursue a targeted approach to lipid management.