Effect of lipid-lowering agents, angiotensin-converting enzyme inhibitors,and calcium antagonists on coronary disease risk

Dyslipidemia is a causative, yet modifiable risk factors for the developmen t of adverse outcomes secondary to coronary artery disease. Recent trials h ave focused on the level of low-density lipoprotein cholesterol (LDL-C) nec essary to achieve maximum reduction in clinical events. Data also exist dem onstrating that intensive lowering of LDL-C in patients with unstable angin a reduces the incidence of adverse clinical events. The statins appear to b e fundamental therapy in patients with established coronary disease as well as a mainstay for those with early evidence of atherosclerosis. The angiot ensin-converting enzyme (ACE) inhibitors have demonstrated a reduction in i schemic events in patients with heart failure. Recent trials of ACE inhibit ors in patients with vascular disease who do not have the traditional indic ations for ACE inhibition have shown a reversal of endothelial dysfunction and a reduction in adverse clinical endpoints. A role for the use of calciu m antagonists in patients with atherosclerosis is less well established, de spite the evidence of excellent results in patients with symptomatic corona ry disease. A recent clinical trial, using a third-generation dihydropyridi ne calcium antagonist with novel mechanisms, found promising results with r egard to its effects on atherosclerosis (C) 2001 by Excerpta Medica, Inc.