High Cholesterol

Though generally not aware of the internal changes in their cholesterol transport patterns, recent trials have demonstrated increasing success with some of these strategies; see the LDL, HDL and IVUS sections. All three of these activities done together can have a positive effect on one s blood cholesterol level. The U.S. Preventive Services Task Force (USPSTF) estimated that after 5 to 7 years of treatment, the relative risk reduction by statins on coronary heart disease events is decreased by approximately 30% 3 4 . More recently, a meta-analysis reported an almost identical relative risk reduction of 29.2% in low risk patients treated for 4.3 years 10 . A relative risk reduction of 19% in coronary mortality was found in a meta-analysis of patients at all levels of risk. The National Cholesterol Education Program revised their guidelines 14 ; however, their 2004 revisions have been criticized for use of nonrandomized, observational data. Clinical Evidence has summarized treatment for both primary prevention 5 and secondary prevention 6 . Two factors to consider when choosing therapy are the patient s risk of coronary disease and their lipoprotein pattern. There is, however, a correlation between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels). This, however, does not mean that a decrease in serum levels is dangerous, as there has not yet been a recorded heart attack in the study in a person with a total cholesterol below 150 mg/dL. Multiple clinical trials, each, by design, examining only one of multiple relevant issues, have increasingly examined the connection between these issues and atherosclerosis clinical consequences. Longstanding elevated hypercholesterolemia leads to accelerated atherosclerosis ; this can express itself in a number of cardiovascular diseases : 2

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