Summary
Lipid disorders are the most important factors in the development of coronary heart disease (CHD). They need to be treated in primary as well as in secondary prevention. U.S. and European Consensus Conferences a greed that desirable serum cholesterol levels should not exceed 200 mg/dL. When baseline cholesterol averages above 250 mg/dL, the minimum requirement for characterizing the lipoprotein disorder is measurement of cholesterol, triglycerides, and high-density lipoprotein (HDL) in the fasting state. In selecting targets for serum lipid values, it may be taken into account that CHD incidence is lowest in persons with serum cholesterol below 180 mg/dL. Any kind of lipid-lowering therapy should be commenced with dietary treatment. If this is ineffective, drugs may be applied additionally. Possible causes of secondary hyperlipidemia should be excluded. There is no strict age limit for treatment but the subject's cardiovascular status should be examined carefully, especially in secondary prevention. The patient in whom extensive myocardial damage is the main arbiter of prognosis is unlikely to gain from strenuous efforts aimed at retarding progression of atheromata, the major causes of CHD. A simple classification distinguishes drugs with a predominant effect on hypercholesterolemia from those effective in endogenous hypertriglyceridemia but with a somewhat weaker cholesterol-lowering action. Using lipid-lowering drugs, their indications and side effects should be considered.
Similar content being viewed by others
References
Pyörälä, K, Rapaport, E, König, K, et al., eds. Secondary Prevention of Coronary Heart Disease. Workshop of the International Society and Federation of Cardiology. Titisee, 21–24 October 1983. Stuttgart and New York: Georg Thieme Verlag, et al. 1983.
Martin, MJ, Hulley, SB, Browner, WS, et al. Serum cholesterol, blood pressure, and mortality: Implications from a cohort of 361,662 men. Lancet 1986;2:933–936.
Keys, A. Seven Countries. A Multivariate Analysis of Death and Coronary Heart Disease Cambridge, Massachusetts and London: Harvard University Press, 1980.
Blackburn, H, Lewis, B, Wissler, RW, et al. Conference on the health effects of blood lipids: Optimal distributions for populations. Prev Med 1979;8:609–759.
NIH Consensus Development Conference Statement: Lowering blood cholesterol to prevent heart disease. JAMA 1985;253:2080–2086.
Study Group of the European Atherosclerosis Society: Strategy for the prevention of coronary heart disease. A policy statement of the European Artherosclerosis Society. Eur Heart J (in press).
World Health Organization Expert Committee: Prevention of Coronary Heart Disease. WHO Technical Report Series 678. Geneva: World Health Organization, 1982.
Primary Prevention of Coronary Heart Disease. Report on a WHO Meeting. EURO Reports and Studies 98. Copenhagen WHO Regional Office for Europe, 1985.
World Health Organization Expert Committee: Community Prevention and Control of Cardiovascular Disease. WHO Technical Report Series 732 Geneva: World Health Organization, 1986.
Stehle, G, Bernhardt, R. Coronary Risk Factors in Japan and China. Berlin, Heidelberg, New York, London, Paris, Tokyo: Springer-Verlag, 1987.
Schettler, G., ed. Endemic Diseases and Risk Factors for Atherosclerosis in the Far East. Berlin, Heidelberg, New York, London, Paris, Tokyo: Springer-Verlag, 1988.
Duffield, RGM, Lewis, B, Brunt, JNH, et al. Treatment of hyperlipidemia retards progression of symptomatic femoral atherosclerosis. A randomized controlled trial. Lancet 1983;2:639–642.
Brensike, JF, Levy, RI, Kelsey, SF, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: Results of the NHLBI type II coronary intervention study. Circulation 1984;69:313–324.
Arntzenius, AC, Krombhout, D, Barth, JD, et al. Diet, lipoproteins and the progression of coronary atherosclerosis. The Leiden Intervention Trial. N Engl J Med 1985;312:805–811.
Rose, G, Shipley, M. Plasma cholesterol concentration and death from coronary heart disease: 10 year results of the Whitehall study. Br Med J 1986;293:306–307.
European Collaborative Trial of multifactorial prevention of coronary heart disease: Final report on the 6-year results. WHO Collaborative Group. Lancet 1986;1:869–872.
Pell, S, Fayerwheather, WE. Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population. 1957–1983. N Engl J Med 1985;312:1005–1011.
Hjerman, I, Velve, Byre K, Holme, I, et al. Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet 1981;22:1303–1310.
Lewis, B. Randomized controlled trial of the treatment of hyperlipidemia on progression of atherosclerosis. Acta Med Scand 1985;101(Suppl):53–57.
Stoffel, W, Bode, C, Borberg, H et al. Selective removal of plasma low-density lipoproteins by combined extracorporeal plasma separation immuno adsorption. In Schettler, G, et al., eds. Atherosclerosis VI. Berlin, Heidelberg, New York: Springer-Verlag, 1983;502.
Eisenhauer, T, Armstrong, VW, Wieland, H, et al. Selective removal of low density lipoproteins (LDL) by precipitation at low pH: First clinical application of the HELP system. Klin Wochenschr 1987;65:161–168.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schettler, G. The role of diet and drugs in lowering serum cholesterol in the postmyocardial infarction patient. Cardiovasc Drug Ther 2, 795–799 (1989). https://doi.org/10.1007/BF00133210
Issue Date:
DOI: https://doi.org/10.1007/BF00133210