Management of high serum cholesterol and related disorders in patients at risk for coronary heart disease

Cholesterol lowering has been shown to be of benefit in reducing the risk of coronary heart disease (CHD) in both patients with established CHD (secondary prevention) and those without (primary prevention). In secondary prevention trials, moderate cholesterol lowering reduced the rate of new events and decreased both morbidity and mortality from cardiovascular disease. In primary prevention, a reduction of cholesterol by 20% has produced a 31% reduction in recurrent coronary morbidity, a 33% reduction in coronary mortality, and 22% less total mortality. The target of therapy is low-density lipoprotein (LDL) cholesterol: in patients with established CHD, goal LDL is ≤100 mg/dL. In high-risk patients without established CHD, the target goal for LDL cholesterol is ≤130 mg/dL. Nondrug measures, bile acid sequestrants, nicotinic acid, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG- CoA) reductase inhibitors all play important roles in cholesterol-lowering therapy.