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Treatment of Cholesterol Abnormalities - Article
ABSTRACT: Cardiovascular disease and its subset coronary heart disease are leading causes of morbidity and mortality in the United States and worldwide. In general, higher levels of low-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease, myocardial infarction, and stroke. Reducing dietary fat can improve total cholesterol levels, but consequent reductions in cardiovascular outcomes are not well documented. The Mediterranean diet is the only dietary intervention associated with a reduction in all-cause mortality. Treatment with cholesterol-lowering medications decreases the rate of cardiovascular events, but a reduction in all-cause mortality with these agents has been found only in patients with pre-existing coronary heart disease. Drug treatment in patients with a history of heart disease and average-to-high cholesterol levels can decrease the risk for stroke. In patients with peripheral vascular disease, treatment of elevated cholesterol levels may slow disease progression.
ABSTRACT: Coronary artery disease is the leading cause of mortality in the United States. In patients who have had a myocardial infarction or revascularization procedure, secondary prevention of coronary artery disease by comprehensive risk factor modification reduces mortality, decreases subsequent cardiac events, and improves quality of life. Options for secondary prevention include medical therapy and surgical revascularization in the form of coronary artery bypass grafting or percutaneous coronary intervention. Medical therapy focuses on comprehensive risk factor modification. Therapeutic lifestyle changes (including weight management, physical activity, tobacco cessation, and dietary modification) improve cardiac risk factors and are universally recommended by evidence-based guidelines. Treatment of hypertension and dyslipidemia reduces morbidity and mortality. Recommendations for persons with diabetes mellitus generally encourage glucose control, but current evidence has not shown reductions in mortality with intensive glucose management. Aspirin, angiotensin-converting enzyme inhibitors, and beta blockers reduce recurrent cardiac events in patients after myocardial infarction. Surgical revascularization by coronary artery bypass grafting is recommended for those with significant left main coronary artery stenosis, significant stenosis of the proximal left anterior descending artery, multivessel coronary disease, or disabling angina. Percutaneous coronary intervention may be considered in select patients with objective evidence of ischemia demonstrated by noninvasive testing.
The Role of Nonstatin Therapy in Managing Hyperlipidemia - Editorials: Controversies in Family Medicine