When to start cholesterol-lowering therapy in patients with coronary heart disease. A statement for healthcare professionals from the American Heart Association Task Force on Risk Reduction

摘要: Strong evidence denotes benefit from reducing serum cholesterol levels in patients with established coronary heart disease (CHD).1 Treatment to decrease recurrent events and reduce total mortality can be called secondary prevention. Support for aggressive cholesterol-lowering therapy as a component of prevention comes meta-analysis earlier trials2 recent large clinical trials.3 4 5 Among the latter, Scandinavian Simvastatin Survival Study (4S),3 which hypercholesterolemic CHD received simvastatin therapy, documented 34% reduction major events, 42% mortality, 30% mortality. Investigators Cholesterol Recurrent Events (CARE) study5 likewise observed significant benefits when pravastatin was given average levels. Several other trials6 7 8 angiographic end points were used show that retards progression atherosclerosis; acute thrombolic arteries also noted. The summed results these different categories trials justify management most CHD. The National Education Program (NCEP)1 calls intensive any form atherosclerotic disease, specifically, myocardial infarction or angina pectoris, artery angioplasty, peripheral arterial abdominal aortic aneurysm, symptomatic carotid history bypass graft. These carry fivefold sevenfold elevated risk developing new thus need reduction. Despite proven CHD, many patients—up two thirds—receive no lower LDL (National Heart, Lung, Blood Institute; unpublished data; 1995). are being deprived valuable treatment will likelihood their having thrombotic …