Comprehensive Lipid Management in the Coronary Artery Disease Patient
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Comprehensive Lipid Management in the Coronary Artery Disease Patient Nivee P. Amin & Michael J. Blaha & Grant V. Chow & Roger S. Blumenthal & Dominique Ashen
Published online: 27 July 2011 # Springer Science+Business Media, LLC 2011
Abstract Low-density lipoprotein cholesterol (LDL-C) is the lipoprotein most implicated in atherosclerosis, and aggressive statin therapy remains the cornerstone of treatment. Adjunct therapies are often required to reach LDL-C goals, and recent studies have only fueled the debate over ezetimibe versus niacin. Alternate dosing regimens of high-potency statins can be used in those who cannot tolerate side effects. Residual risk may remain after LDL-C goals are achieved. Non–high-density lipoprotein cholesterol (non–HDL-C) must be calculated in patients with elevated triglycerides. Omega-3 fatty acids are most effective in lowering non–HDL-C. Low HDL-C levels can be raised with niacin, but clinical events may not be significantly reduced. Newer therapeutic targets, such as cholesteryl ester transfer protein (CETP) inhibitors, raise HDL-C and are being evaluated for safety and efficacy. Several ongoing, randomized controlled trials are investigating the relative efficacy of adjunctive therapies for N. P. Amin (*) : M. J. Blaha : G. V. Chow : R. S. Blumenthal : D. Ashen The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 North Wolfe Street Carnegie 568 Cardiology, Baltimore, MD 21287, USA e-mail: [email protected] M. J. Blaha e-mail: [email protected] G. V. Chow e-mail: [email protected] R. S. Blumenthal e-mail: [email protected] D. Ashen e-mail: [email protected]
reducing coronary heart disease events in high-risk patients. Keywords Lipid management . Coronary heart disease . Atherosclerosis . Adjunct therapy . Statin . Secondary prevention . Niacin . Omega-3 fatty acid . Lipid guidelines . Cholesteryl ester transfer protein inhibitor . Low density lipoprotein . High density lipoprotein . Triglycerides . Non-high density lipoprotein
Introduction Coronary heart disease (CHD) is a major contributor to morbidity and mortality among adults worldwide, and lipid management remains one of the cornerstones of treatment. Nearly all of the 17,600,000 CHD patients in the United States have some degree of dyslipidemia [1]. Effective treatment requires a multidisciplinary approach that can result in significant challenges for the clinician. It is estimated that a significant minority of CHD patients are receiving no or suboptimal lipid-lowering therapies, as Just 17% to 73% of CHD patients achieve target levels. Many of these discrepancies are attributable to the challenges a clinician may face in targeting appropriate lipid levels based on risk, achieving target levels, and maintaining adherence to therapies [2]. It is our goal to bring the reader up to date on important new findings in lipid management. Our discussion focuses on current guidelines, treatment options, and future directions for therapies. In particular, we discuss optimal statin therapies, non–high-density lipoprot
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