TREATMENT OF ELEVATED CHOLESTEROL PLASMA- LEVELS IN THE SECONDARY PREVENTION OF CORONARY HEART-DISEASE

In secondary prevention of coronary heart disease, the reduction of el evated cholesterol plasma levels is mainly based on diet and/or drugs. Invasive means such as partial ileal bypass operation or LDL-apheresi s, although highly effective in reducing cholesterol levels and incide nce of clinical cardiac events, should be reserved for special subgrou ps of patients. With dietary measures such as strict reduction of calo ries originating from fat, as well as with increased consumption of fi sh, fruits, vegetables and cereals, clinical or angiographic benefits could be demonstrated; in addition to the reduction of cholesterol pla sma levels, other mechanisms such as inhibition of platelet aggregatio n and protection of LDL-particles from oxidation may contribute to thi s effect. With drugs reduction of cardiac events and of cardiac and to tal mortality was not observed in all clinical studies. Most angiograp hic drug studies revealed a significant, although quantitatively moder ate retardation of the progression of coronary artery disease. However , only in a few studies did the clinical or angiographic effects corre late with the extent of changes in total, LDL- or HDL-cholesterol plas ma levels or their absolute values on trial. Women and men seem to ben efit equally from drug therapy. The efficiency of cholesterol-lowering measures in patients with age > 70 years is still unknown, however. I n patients with coronary artery disease and normal cholesterol plasma levels neither clinical nor angiographic benefits could so far be demo nstrated with cholesterol-lowering measures, Thus, to date in the seco ndary prevention of coronary artery disease cholesterol-lowering thera py with drugs only seems definitely indicated in patients < 70 years o f age with hypercholesterolemia resistant to diet.