MANAGEMENT OF HYPERCHOLESTEROLEMIA

Abstract

Coronary heart disease (CHD) remains the leading cause of death and is a major cause of morbidity among men and women in the United States. 3 The role of elevated concentrations of serum cholesterol and low-density lipoprotein (LDL) in the pathogenesis of atherosclerosis is well established. Evidence supporting the atherogenic effects of LDL include studies of diet-induced atherosclerosis in animals; clinical studies in humans with genetic disorders, such as familial hypercholesterolemia , that are associated with a high risk for premature atherosclerosis; and pathologic studies, demonstrating that cholesterol derived from LDL is present in atherosclerotic plaques . Epidemiologic studies have consistently shown higher rates of CHD in populations with higher mean concentrations of total and LDL cholesterol , and migration studies demonstrate increased rates of CHD in groups that have moved from a low-cholesterol to a high-cholesterol environment. Results from the Multiple Risk Factor Intervention Trial (MRFIT), in which CHD mortality was assessed in 356,222 men followed for more than 6 years, demonstrated a curvilinear relationship between increasing plasma concentrations of total cholesterol and risk for CHD. The risk increased slightly as total cholesterol values rose from 150 to 200 mg/dL but was approximately 2 and 4 fold higher when cholesterol values were increased to 250 and 300 mg/dL compared with values at 200 mg/dL. 59