DRUG-THERAPY OF SEVERE HYPERCHOLESTEROLEMIA IN PATIENTS WITH CORONARY-ARTERY DISEASE

The beneficial effect of cholesterol-lowering therapy for secondary pr evention in patients with coronary artery disease (CAD) is well establ ished. The therapeutic goal in this situation is a low-density lipopro tein (LDL) cholesterol level of 100 mg/dl. Cholesterol-lowering therap y will not only lead to a reduction in the progression of lesions but also and probably more importantly will reduce lesion activation and r upture and improve endothelial vasomotor function. Depending on the un derlying hyperlipoproteinemia, the first choice for single drug therap y is a bile acid-binding resin or a hepatic hydroxymethyl glutaryl coe nzyme A (HMG-CoA) reductase inhibitor in isolated LDL hypercholesterol emia, and nicotinic acid, a fibric acid, or a HMG-CoA reductase inhibi tor in combined hyperlipidemia. Combination therapy usually consists o f a bile acid-binding resin with ei ther an HMG-CoA reductase inhibito r, a fibric acid, or nicotinic acid in LDL hypercholesterolemia and ni cotinic acid with a fibric acid in combined hyperlipidemia.