Cholesterol lowering in atherosclerosis

Lipid-lowering with statins reduces disease progression, prevents myocardia l infarction and other hard end points, and prolongs survival. Data from la rge-scale trials with these agents further show that lowering low-density l ipoprotein (LDL) cholesterol in patients with coronary artery disease reduc es the incidence of cardiovascular events and that the lower the LDL choles terol achieved, the lower the event rate. Currently available evidence supp orts the National Cholesterol Education program (NCEP) recommendations for reduction of LDL-cholesterol levels to at least 100 mg/dL in patients with coronary artery disease. The Treating to New Targets study, which will eval uate the effects of LDL-cholesterol lowering to less than or equal to 75 mg /dL with atorvastatin, may help clarify if additional benefit accrues with further reductions, However, up to 82% of patients with proven coronary dis ease are not even at the current NCEP lipid goal, Up to 55% need a >30-mg/d L reduction in LDL cholesterol to reach that goal. These data suggest that many patients are not receiving a statin or are receiving on inadequate dos e. Aggressive lipid lowering, although a desirable goal, does not yet appea r to be standard practice, (C) 2000 by Excerpta Medica, Inc.