Treatment of hyperlipidemia

The correlation between elevated cholesterol and coronary artery disease (CAD) has emerged slowly, with the strongest statistical links appearing recently. Every major epidemiologic study carried out to date has verified the association between the concentration of serum cholesterol and the risk of CAD. Despite this, much of the medical profession continues to underrate the significance of cholesterol and lipoproteins. Programs to increase physicians' awareness of this problem are essential. The National Heart, Lung, and Blood Institute's Coronary Primary Prevention Trial showed that diet and drug therapy lower cholesterol by 9% and low density lipoprotein (LDL) cholesterol by 12.5%, on average, in at-risk patients compared with control subjects. CAD death or nonfatal myocardial infarctions were reduced collectively by 19%. Significant decreases also occurred in the incidence of angina pectoris, new positive electrocardiograms and coronary artery bypass surgery. Data from a number of important secondary prevention trials also support lowering cholesterol and LDL to retard the growth of atherosclerotic plaque. The risk from LDL elevations depends on the extent of the increase, the concentration of high density lipoprotein cholesterol and the presence of other major risk factors (e.g., hypertension and smoking). The ratio of total cholesterol or LDL to the high density lipoprotein concentration is the best indicator for CAD risk. Monitoring cholesterol levels should become an annual routine in the physician's office. A simple, economical blood test for cholesterol, which should be widely available soon, will make screening programs possible, but before such screening begins, plans must be in place for follow-up. The identification of high risk persons and their treatment with diet and, when necessary, drugs are essential. Moreover, the means are now available for lowering cholesterol and LDL in the general population.