lipid-lowering drugs prevention strategy
Springer Online Journal Archives 1860-2000
Chemistry and Pharmacology
Summary There is overwhelming evidence from prospective studies that plasma cholesterol levels are exponentially related to coronary artery disease (CAD) risk. Inversely, the beneficial effect of lowering plasma cholesterol is convincingly established from major clinical trials. A consensus has been reached in a large number of countries on the need to lower plasma lipid levels, especially LDL-cholesterol, to delay the onset, slow the progression and induce regression of atherosclerotic lesions in the coronary arteries. This remains the major indication of lipid-lowering therapy. In recent years, the emphasis has been put on target plasma lipid concentrations for dietary and drug therapy. In the process of establishing prevention strategies, however, some confusion arose: target values and criteria for assessing CAD risk and initiating therapy have differed from country to country, as well as among various groups within a country. Population strategies and high-risk case-finding strategies have clashed. Treatment algorithms have emphasized lipid levels rather than lipid transport disorders. With time, these algorithms have become more and more complex and the confused physician in practice, sometimes, has started to treat mg/dL (or mmol/L) rather than patients. This confusion has been compounded by debates on the variability of plasma lipid measurements within as well as across laboratories. In the one to one relationship that exists in the physician's office, much of this confusion can be dispelled if, after a thorough clinical evaluation, the patient's situation is taken in context, a diagnosis is made and the indicated therapy is prescribed. A good algorithm is one that focuses first on diagnosis, separates secondary from primary causes of dyslipoproteinemia, starts with diatary therapy, targets drugs to the metabolic disturbance, takes into account the psycho-social environment and the risk factor context and adjusts the treatment according to the observed response. Within this framework, specific target levels may be given due consideration. Treatment should be individualized and the key lipid transport disorders identified. Today, the physician has the advantage of prescribing drugs that have been proven valuable for the ultimate goal of therapy: prevention of atherosclerotic complications.
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