Cholesterol: Precursor to many lipid disorders

Despite advances in treatment and prevention, coronary heart disease (CHD) remains the leading cause of death in the United States. A major risk facto r for CHD is elevated low-density lipoprotein cholesterol (LDL-C). Randomiz ed clinical trials have proven that lowering LDL-C to near target levels si gnificantly reduces CHD risk. More aggressive LDL-C reductions would have a n even greater impact on reducing CHD risk if these goal levels were applie d to all patients at risk, as identified by a CHD risk prediction scoring s ystem. In 1993 the second Adult Treatment Panel (ATP II) of the National Ch olesterol Education Program issued guidelines that defined CHD risk on the basis of whether a patient qualified for primary or secondary prevention. T he ATP III guidelines, issued May 2001, introduce the concept I CHD-equival ent risk in patients without known CHD, thereby expanding considerably the number of people eligible for lipid-lowering therapy. Unfortunately, many p atients who are eligible for therapy are not receiving it, and among those on lipid-lowering therapy, less than half have achieved their treatment goa ls. As mentioned, findings from several large-scale primary- and secondary- prevention trials with statins and other lipid-lowering agents have shown t hat lowering LDL-C reduces the risk for fatal and nonfatal coronary events and results in fewer hospitalizations and revascularization procedures. In fact, a review of the 5 major statin trials reveals that the higher the pat ient's baseline CHD risk, the more striking the benefits of therapy are. Cl early, the need to lower LDL-C levels is crucial. Meeting this need involve s targeting patients who are at risk, implementing appropriate treatment, a nd ensuring compliance with therapy.