Critical appraisal of revised cholesterol guidelines for the very high-risk patient.
A working group from the Adult Treatment Panel III of the national Cholesterol Educational Program issued a revised algorithm for low-density lipoprotein (LDL)-cholesterol lowering in very high-risk cardiovascular disease patients. The rationale of these recommendations was primarily established from pooled analysis of multiple clinical trials of LDL-cholesterol-lowering therapies and limited data from an acute coronary syndrome trial. In the near future, the findings of these large-scale randomized trials designed to test the hypothesis that more aggressive LDL-cholesterol therapy is accompanied by fewer cardiovascular events than less aggressive LDL-cholesterol lowering therapy, will provide the evidence needed to support or refute these new recommendations. In this article, the authors suggest that an LDL-cholesterol level of less than 70 mg/dl is unattainable and not necessary for many high-risk patients. Furthermore, the potential risks associated with high-dose statin agents in certain patients, such as the elderly, may outweigh these putative benefits.
Rosenson
Robert
R
The Feinberg School of Medicine, Division of Cardiology, Chicago, IL 60611, USA. r-rosenson@northwestern.edu
Lloyd-Jones
Donald
D
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL