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Clinical trials of cholesterol lowering in patients with cardiovascular disease or diabetes

Author
Robert S Rosenson, MD
Section Editor
Mason W Freeman, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

The preeminent role of low-density lipoprotein cholesterol (LDL-C) in the pathogenesis and perpetuation of atherosclerotic vascular disease has emerged from many sources [1-4]. The Lipid Research Clinics Prevalence Study, for example, evaluated the influence of lipids on 10-year cumulative coronary heart disease (CHD) death rates in patients with and without CHD [2]. The CHD death rate increased at higher plasma concentrations of total and LDL-C for both cohorts, but the impact of elevated lipid levels was significantly greater in subjects with preexisting CHD (figure 1).

The major clinical trials that have addressed cholesterol lowering in patients with known CHD, including myocardial infarction (MI), angina, and prior coronary revascularization; other cardiovascular disease (CVD), including symptomatic carotid artery disease, peripheral vascular disease, abdominal aortic aneurysm; or combinations of risk factors that result in a 10-year risk of CVD events of more than 20 percent (table 1) are discussed here. Major trials in patients with diabetes mellitus are also discussed here, although not all such patients are at high risk of having CVD. (See "Treatment of lipids (including hypercholesterolemia) in secondary prevention", section on 'Diabetes mellitus and CV risk'.)

Recommendations for the management of patients with known CVD are discussed in detail separately. (See "Treatment of lipids (including hypercholesterolemia) in secondary prevention" and "Intensity of lipid lowering therapy in secondary prevention of cardiovascular disease".)

The trials of cholesterol lowering in primary prevention (ie, in patients without known CVD) and recommendations for management of such patients are also discussed separately. (See "Clinical trials of cholesterol lowering for primary prevention of coronary heart disease" and "Treatment of lipids (including hypercholesterolemia) in primary prevention".)

LIFESTYLE MODIFICATION

Initial studies with conventional dietary modification (National Cholesterol Education Program [NCEP] Step 1 or Step 2 diet) showed little benefit on established coronary atherosclerosis, especially when compared with drug therapy (table 2). However, more positive results have been reported in trials that investigated more aggressive dietary therapy alone [5-7] or in combination with exercise [8,9]. These studies have employed various regimens directed at lowering the consumption of dietary fat, saturated fat, and cholesterol.

                                                    

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Literature review current through: Nov 2016. | This topic last updated: Thu Mar 10 00:00:00 GMT+00:00 2016.
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