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Regression and stabilization of coronary artery lesions. Angiographic trials move beyond the NCEP treatment
1University of Nebraska Medical Center, Omaha 68198.
Insights
National Cholesterol Education Program (NCEP) guidelines may not be suitable for patients with existing coronary artery disease. Lowering cholesterol and LDL levels below NCEP recommendations may stabilize or regress atherosclerotic lesions.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Preventive Cardiology
Background:
- National Cholesterol Education Program (NCEP) guidelines for hypercholesterolemia are based on population studies.
- Population studies may not accurately reflect lipid management needs in patients with established coronary artery disease.
Purpose of the Study:
- To evaluate the relevance of NCEP guidelines for patients with established coronary artery disease.
- To explore the potential impact of lipid modification on atherosclerotic lesion progression and regression.
Main Methods:
- Analysis of recent coronary angiographic studies.
- Comparison of lipid levels in small patient groups undergoing angiography.
Main Results:
- Angiographic studies suggest atherosclerotic lesions can be stabilized or regress.
- Achieved cholesterol and LDL levels in these studies were below NCEP guidelines.
- Aggressive lipid management may influence disease course in patients with coronary disease.
Conclusions:
- NCEP guidelines may not be optimal for patients with established coronary disease.
- Lowering cholesterol and LDL levels significantly may lead to lesion regression.
- Tailored lipid management is crucial for altering the course of established coronary artery disease.
Abstract:
National Cholesterol Education Program Guidelines for the diagnosis and treatment of hypercholesterolemia have been formulated from population studies relating coronary events to blood lipids. Such population studies may not be relevant to patients with established coronary disease. Recent coronary angiographic studies allow meaningful comparisons of small groups of patients. These studies suggest that atherosclerotic lesions in coronary arteries can be stabilized, and further, that regression of coronary lesions can occur. The cholesterol and LDL levels achieved in angiographic studies are well below NCEP guidelines. Careful attention to correcting lipid abnormalities in patients with established coronary disease may alter the course of their illness.