Lipid-lowering therapy after an atherosclerotic event

Abstract

w en considering lipid-lowering therapy (diet f drug) for a patient who has had an atherosclerotic event, the following facts might be considered: 1. Whatever the levels of the serum (or plasma) total and low-density lipoprotein (LDL) cholesterol in the patient with an atherosclerotic event, they are too high for that particular patient. 2. The greatest risk factor for a subsequent atherosclerotic event is a previous atherosclerotic event. 3. The greatest danger period for a subsequent atherosclerotic event is the first 6 months after the previous atherosclerotic event. 4. The higher the serum total and LDL cholesterol levels, the greater the chance of a subsequent atherosclerotic event. 5. Portions of atherosclerotic plaques disappear (“reverse”) when the total and LDL cholesterol levels are lowered, and when portions of plaques disappear the arterial lumens widen and blood flow to the organ supplied increases. 6. The greater the percent decrease in serum total and LDL cholesterol levels, the greater the disappearance (reversibility) of portions of atherosclerotic plaques. 7. Diet therapy alone (percent of calories from fat reduced from 40 to 30%) usually lowers the serum total and LDL cholesterol levels only about lo%, and a reduction of this magnitude probably causes little to no disappearance of portions of atherosclerotic plaques. 8. Most persons having atherosclerotic events have serum total cholesterol levels from 200 to 240 mg/dl(5.2 to 6.2 mmol/liter) and LDL cholesterol levels from 130 to 160 mg/dl (3.4 to 4.1 mmol/liter). If the aforementioned 8 items are accepted as facts, is it appropriate to manage serum cholesterol levels in persons who have had atherosclerotic events in the same fashion as these levels are managed in persons who have not had atherosclerotic events? My answer is “no.” To better understand this answer it may be useful to summarize the therapeutic guidelines of the Adult Treatment Panel (29 members) of the National Cholesterol