, Volume 3, Issue 5, pp 323-330
Date: 26 Aug 2009

Achieving optimum lipid-lowering goals in patients with vascular disease

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Individuals with established cardiovascular disease are at high risk for serious adverse ischemic events. Fortunately, effective control of serum cholesterol levels, especially low-density lipoprotein (LDL), can significantly reduce cardiovascular morbidity and mortality. To achieve these benefits, the evidence-based National Cholesterol Education Program-Adult Treatment Panel III Guidelines recommend an LDL goal of less than 100 mg/dL with a secondary non-high-density lipoprotein (HDL) goal of less than 130 mg/dL. The more aggressive optional goals are an LDL less than 70 mg/dL and a non-HDL of less than 100 mg/dL. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) exert potent LDL-lowering as well as pleiotropic effects, and these agents have consistently reduced cardiac mortality and myocardial infarction in trials of secondary prevention. Should a statin drug alone fail to achieve the goal due to resistance or patient intolerance, combination drug therapy can be used. Combination therapy may also help achieve secondary goals for the reduction of non-HDL cholesterol levels.