Primary prevention of coronary heart disease: role of cholesterol control in the United States

Abstract

The benefit of cholesterol‐lowering drug therapy in patients with existing coronary heart disease (CHD) is well established through clinical trials. Prevention of recurrent coronary morbidity and mortality in CHD patients is called secondary prevention. In contrast, primary prevention is delaying or preventing altogether new‐onset CHD. There are three categories of primary prevention: high‐risk, moderate‐risk, and long‐term (life‐time). A recent clinical trial has documented benefit of cholesterol‐lowering drugs for prevention of coronary morbidity and mortality and total mortality in hypercholesterolemic, middle‐aged men. This trial lends support for including aggressive cholesterol reduction in high‐risk primary prevention. However, for such therapy to be cost effective at present‐day prices of cholesterol‐lowering drugs, only those patients in the higher ranges of risk can be selected for treatment. This leaves a large number of people at moderately high risk for premature CHD because of high cholesterol levels. These persons deserve increased professional attention to risk reduction. In general the nondrug approach is indicated. The latter approach includes eliminating other risk factors, e.g. cigarette smoking and hypertension, and reducing serum cholesterol levels by decreased intakes of saturated fatty acids, cholesterol, and excess total calories. Some moderate‐risk patients may require low doses of cholesterol‐lowering drugs to achieve the goals for cholesterol reduction. Finally, public health strategies need to be developed for applying the same nondrug approach for the general population for reducing the overall incidence of CHD.

Effect of Physician-Delivered Nutrition Counseling Training and an Office-Support Program on Saturated Fat Intake, Weight, and Serum Lipid Measurements in a Hyperlipidemic Population

“…A 10% reduction in energy from saturated fat, associated with a weight loss of 2.3 kg, a modest reduction in LDL cholesterol levels, and a favorable shift in the cholesterol-HDL ratio in patients not receiving pharmacological therapy, maintained 1 year out from the intervention, has important public health implications. 19 The magnitude of the weight loss seen in patients in group 3 was unexpected. Obesity is a causal factor in many chronic diseases, and the accelerating rate of increase in the prevalence of obesity seen in the United States over the last decade presents a formidable challenge.…”

Association of rs2072183 SNP and serum lipid levels in the Mulao and Han populations

“…Unfavorable lipid profiles include high levels of plasma or serum total cholesterol (TC) [1,2], low-density lipoprotein cholesterol (LDL-C) [3,4] and apolipoprotein (Apo) B [5,6], and low levels of high-density lipoprotein cholesterol (HDL-C) and ApoAI [7,8]. Especially, elevated TC and LDL-C levels were well-established risk factors for atherosclerosis and coronary heart disease [2,9,10]. However, the source of the serum lipids in human mainly relies on endogenous synthesis and the intestinal absorption which occupied more than 50% of the amount from dietary [11].…”

Intracranial Arteries of Human Fetuses Are More Resistant to Hypercholesterolemia-Induced Fatty Streak Formation Than Extracranial Arteries

“…[1][2][3][4][5][6][7] However, the role of hypercholesterolemia in atherosclerotic cerebrovascular disease is still debated. 8 Although intracranial arteries eventually develop advanced atherosclerotic lesions, the onset of atherogenesis in intracranial arteries occurs much later in life and the severity of lesions is generally less pronounced than that in extracranial arteries, both in humans 8 -10 and nonhuman primates.…”