[Role of LDL in cardiovascular diseases. New data and new recommendations].
The management of hypercholesterolemia has rapidly progressed with the large clinical trials mainly on statins. Over the past 15 years, it has been demonstrated that the principle target was LDL-cholesterol and that treatment with statins decreased cardiovascular morbidity and global mortality. The studies have progressively targeted patients with increasingly lower cholesterol levels but always at high risk. Recent data are in favour of the so-called "aggressive" strategy aimed at reducing cholesterol to very low levels. The emergence of new therapies with stronger statins and the concept of combining lipid-lowering treatments has improved the chances of reaching this aim. Prompted by this progress, the transposition of this aggressive strategy to clinical practice is confronted with many problems, which stem from practitioners' and patients' reticence and fears (raising the question of compliance to treatment) and, more generally, the problem of cost. In this perspective, therapeutic education is one of the tools that would promote compliance. New treatments in the field of HDL would further support the progress made in such prevention.
Bruckert
E
E
Unité d'exploration métabolique pour la prévention des maladies cardiovasculaires, Hôpital Pitié-Salpêtrière, Paris (75), France.
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008078:Cholesterol, LDL; D002986:Clinical Trials as Topic; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications* / Q000517:prevention & control*; D010349:Patient Compliance; D010641:Phenotype; D017410:Practice Guidelines as Topic
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL