CHOLESTEROL MANAGEMENT IN HIGH-RISK PATIENTS WITHOUT HEART-DISEASE - WHEN IS LIPID-LOWERING MEDICATION WARRANTED FOR PRIMARY PREVENTION

A particularly important question for primary prevention of CHD is whe n to initiate cholesterol-lowering drugs in patients at risk. The two most important factors to consider are the serum LDL cholesterol level and the absolute risk, based on the presence or absence of other risk factors. The intensity of therapy can be modified according to the ot her risks at play. For example, diabetes mellitus is a particularly po werful risk factor for morbidity and mortality from CHD. Therefore, mi ddle-aged or elderly diabetic patients call reasonably be treated as i f they already have established CHD. Other risk factors are less dange rous, but when a patient has several such factors, intensive cholester ol lowering therapy often is indicated. Except for patients at highest risk, a 3- to 6-month trial of nondrug therapy is warranted in an eff ort to achieve the target of therapy without drugs or with low doses o f drugs. If patients are appropriately selected for therapy, cholester ol management for primary prevention of CHD should rival secondary pre vention in reducing the burden this: disorder imposes on society.