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Spring 2005

High Cholesterol Treated More Aggressively

“In the last year, it has become clear that we need to be more aggressive in lowering lipid levels of patients at highest risk,” says Helga Van Herle, M.D., a cardiologist at UCLA Medical Center. “We need to make sure their LDL cholesterol is less than 70 mg/dL, and to aggressively initiate drug therapy in this group of patients.”

The National Cholesterol Education Program issued updated clinical practice guidelines last year based on a review of five large clinical trials of statin therapy that had been launched since the program’s 2001 recommendations. For the highest-risk patients—those with established cardiovascular disease—the new guidelines call for lowering low-density lipoprotein (LDL, or “bad” cholesterol) levels to 70 mg/dL. This group includes patients who have had previous heart attacks or have diabetes mellitus. Lower-risk patients are still advised to aim for LDL levels under 130.

High lipid levels cause progression of atherosclerosis —the thickening of the artery walls—that can lead to cardiovascular disease. Statins, which inhibit one of the enzymes that form cholesterol, are considered the most effective drug class, Dr. Van Herle notes, though in rare cases patients need to switch to other therapies because of side effects that can include muscle weakness and liver function abnormalities. She points out that statins may have the added benefit of lowering the Creactive protein, a marker of arterial inflammation that recent studies suggest might be as important to preventing heart attacks and strokes as lowering LDL cholesterol.

Regular cardiovascular exercise and a diet low in saturated fats remain vital strategies for optimizing cholesterol levels—and no less critical even after starting on the cholesterol-lowering medications, she notes.

However, some individuals will require medication even if their lifestyle behaviors are exemplary.

 “Many patients don’t realize that the medication is just an adjunct therapy for controlling cholesterol,” says Dr. Van Herle. “You still need to eat right, be physically active, and reduce other risks such as not smoking. The drugs are only part of the overall treatment strategy.”

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