An Aggressive and Safe Approach for Dyslipidemia Drug Therapy*

The National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP III) guidelines call for immediate intervention in individuals with established coronary heart disease (CHD). The significance of immediate intervention was based in part on our understanding of plaque stability versus morphology (ie, the nature of the plaque, not the size, determines its vulnerability to thromboses). The sequelae of a ruptured plaque are dangerous and often deadly. Statins, through their ability to significantly reduce lowdensity lipoprotein cholesterol levels, can drastically reduce the risk of a future CHD event. This article reviews the epidemiologic statistics regarding CHD, with an emphasis on the lethality of this disease and the overall risk versus the risk of any side effects of statins. The risk factors for CHD as outlined by the NCEP ATP III guidelines are reviewed. The guidelines recommend 2 types of treatment based on CHD risk: therapeutic lifestyle changes and drug treatment. Realistic outcomes with these types of therapies are reviewed as well as ongoing clinical studies and new drug therapies recently approved by the US Food and Drug Administration. Aggressive and early intervention to prevent CHD (both primary and secondary prevention) is essential, and it is quite safe. The onus is on primary care physicians to identify patients early and initiate statin therapy before the first clinical signs of CHD develop. (Adv Stud Med. 2004;4(1B):S44-S52)