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[Modifying increased plasma cholesterol levels in secondary prevention of coronary heart disease]
1Abteilung Kardiologie, Medizinische Hochschule Hannover.
Insights
Lowering high cholesterol through diet or drugs aids secondary prevention of coronary heart disease. Drug therapy is primarily recommended for patients under 70 with diet-resistant hypercholesterolemia.
Area of Science:
- Cardiology
- Preventive Medicine
- Metabolic Disorders
Background:
- Secondary prevention of coronary heart disease (CHD) often involves managing elevated cholesterol plasma levels.
- Dietary and pharmacological interventions are primary approaches, while invasive methods are reserved for specific patient subgroups.
- Clinical benefits of dietary changes include reduced cardiovascular events and disease progression, potentially through mechanisms beyond cholesterol reduction.
Purpose of the Study:
- To evaluate the effectiveness of cholesterol-lowering measures in the secondary prevention of coronary heart disease.
- To compare the outcomes of dietary interventions versus pharmacological treatments for managing hypercholesterolemia in CHD patients.
- To identify patient subgroups most likely to benefit from specific cholesterol-lowering therapies.
Main Methods:
- Review of clinical studies on dietary interventions (fat restriction, increased intake of fish, fruits, vegetables, cereals) for CHD secondary prevention.
- Analysis of data from drug intervention trials assessing effects on cholesterol levels, cardiac events, mortality, and angiographic progression.
- Examination of factors influencing treatment efficacy, including patient age, baseline cholesterol levels, and gender.
Main Results:
- Dietary measures demonstrated clinical and angiographic benefits, with potential additional effects on platelet aggregation and LDL oxidation.
- Drug therapies showed moderate retardation of coronary artery disease progression in most angiographic studies, but reductions in cardiac events and mortality were inconsistent.
- Treatment efficacy did not consistently correlate with changes in total, LDL, or HDL cholesterol levels; women and men appeared to benefit equally.
- Cholesterol-lowering measures showed no benefit in patients with normal cholesterol levels or those over 70 years old.
Conclusions:
- Cholesterol-lowering therapy is most definitively indicated for secondary CHD prevention in patients under 70 with hypercholesterolemia resistant to diet.
- Dietary interventions offer multifaceted benefits beyond lipid reduction in CHD secondary prevention.
- Further research is needed to determine the efficacy of cholesterol-lowering measures in elderly patients (over 70) with CHD.
Abstract:
In secondary prevention of coronary heart disease, the reduction of elevated cholesterol plasma levels is mainly based on diet and/or drugs. Invasive means such as partial ileal bypass operation or LDL-apheresis, although highly effective in reducing cholesterol levels and incidence of clinical cardiac events, should be reserved for special subgroups of patients. With dietary measures such as strict reduction of calories originating from fat, as well as with increased consumption of fish, fruits, vegetables and cereals, clinical or angiographic benefits could be demonstrated; in addition to the reduction of cholesterol plasma levels, other mechanisms such as inhibition of platelet aggregation and protection of LDL-particles from oxidation may contribute to this effect. With drugs reduction of cardiac events and of cardiac and total mortality was not observed in all clinical studies. Most angiographic drug studies revealed a significant, although quantitatively moderate retardation of the progression of coronary artery disease. However, only in a few studies did the clinical or angiographic effects correlate with the extent of changes in total, LDL- or HDL-cholesterol plasma levels or their absolute values on trial. Women and men seem to benefit equally from drug therapy. The efficiency of cholesterol-lowering measures in patients with age > 70 years is still unknown, however. In patients with coronary artery disease and normal cholesterol plasma levels neither clinical nor angiographic benefits could so far be demonstrated with cholesterol-lowering measures. Thus, to date in the secondary prevention of coronary artery disease cholesterol-lowering therapy with drugs only seems definitely indicated in patients < 70 years of age with hypercholesterolemia resistant to diet.