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Lipid-lowering update 2001. Aggressive new goals
1Royal Alexandra Hospital, Edmonton. tfenske@netcom.ca
Insights
Lowering cholesterol, particularly low-density lipoprotein (LDL), significantly improves survival and reduces cardiac events in patients with coronary artery disease (CAD). Aggressive risk factor modification is crucial for high-risk individuals.
Area of Science:
- Cardiology
- Metabolic Disorders
Background:
- Cholesterol plays a central role in the development of coronary artery disease (CAD).
- Identifying patients at high risk for CAD is essential for effective intervention.
Purpose of the Study:
- To review the role of cholesterol in CAD.
- To emphasize the importance of identifying high-risk patients.
- To discuss the treatment of dyslipidemias.
Main Methods:
- Literature search of MEDLINE (1995-2000) using keywords: cholesterol, risk reduction, statins.
- Focus on large randomized controlled trials, recent articles, and landmark clinical trials.
Main Results:
- Lipid-lowering therapies, especially low-density lipoprotein (LDL) reduction, demonstrably improve survival and reduce cardiac events in primary and secondary prevention.
- High-risk patient groups now include those with diabetes mellitus, peripheral vascular disease, and established CAD.
- Comprehensive lipid profiles are necessary for risk assessment and tailored lipid-lowering strategies.
Conclusions:
- Effective and well-tolerated cholesterol-modifying therapies are available.
- Lipid normalization is a mandatory goal for physicians managing patients with established CAD or those at risk.
Objective:
To review the central role of cholesterol in coronary artery disease (CAD), underscore the need for identifying patients at high risk of CAD, and discuss treatment of dyslipidemias.
Quality Of Evidence:
Current literature (1995-2000) was searched via MEDLINE using the MeSH headings "cholesterol," "risk reduction," and "statins." Recommendations in this paper are based mainly on the results of large randomized controlled trials. Preference was given to more recent articles, clinically relevant articles, and landmark clinical trials.
Main Message:
Lipid lowering, and specifically low-density lipoprotein lowering, has been repeatedly shown in large clinical trials to improve survival dramatically and reduce cardiac events in both primary and secondary prevention. Identifying those at highest risk for future cardiac events is critical because these patients will benefit most from aggressive modification of risk factors. The definition of high risk has been expanded to include patients with diabetes mellitus and peripheral vascular disease, as well as those with established CAD. A full lipid profile is required for these patients to assess risk and develop a lipid-lowering strategy with proven effectiveness.
Conclusion:
With the advent of powerful, efficacious, and well tolerated cholesterol-modifying therapies, lipid normalization should be a mandate for all physicians caring for patients with established CAD and patients at risk of developing CAD.