Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia

Dietary cholesterol and egg yolks: Not for patients at risk of vascular disease

“…Nothing could be further from the truth. Although statins lower coronary artery disease risk by 25% to 40% and possibly more, it has been estimated that diet may account for 85% of coronary risk (15), and in the best of circumstances, statins still leave a residual coronary risk in the order of 70% in major clinical trials (16).…”

Risk Estimation in 2009

“…Clinical trials have documented the benefits of statin lipidlowering drug therapy in both primary and secondary prevention across age and sex groups and even for those with relatively low LDL and ApoB levels. 8 Among a population with prevalent atherosclerosis, the risk of having a heart attack at any particular time is extremely difficult to measure. The conversion of the atherosclerosis to clinical disease usually requires changes in the atherosclerotic plaque, for example, the vulnerable plaque, hemorrhage, rupture, or erosion of the plaque as well as factors that increase the risk of thrombogenesis and decreased fibrinolysis.…”

The treatment of cholesterol: issues, effects and targets

“…3 There are no intrinsic dangers to lowering LDL cholesterol, and no hard evidence to the contrary exists. Large randomised trials demonstrated a reduction in total mortality.…”

“…Should we be initiating preventive measures earlier? 3 Fatty streaks can already be demonstrated in adolescents and can be extensive by 30 years of age. We do treat highrisk children, e.g.…”