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Management of low density lipoprotein cholesterol (LDL-C) in secondary prevention of cardiovascular disease

Authors
Robert S Rosenson, MD
Rodney A Hayward, MD
Jose Lopez-Sendon, MD, PhD
Section Editors
Mason W Freeman, MD
Christopher P Cannon, MD
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Patients with known cardiovascular disease (CVD) are at high risk for future CVD events. Therapy to reduce the risk of subsequent events in such patients is referred to as secondary prevention. Secondary prevention interventions are aimed at known modifiable risk factors CVD events such as smoking, hypertension, diabetes, and elevated levels of low density lipoprotein cholesterol (LDL-C). LDL-C lowering has been shown in large clinical trials to reduce the risk of CVD events and, in some populations, to reduce all-cause mortality.

This topic will review the evidence for the benefit from lowering LDL-C in secondary prevention as well as our treatment approach. The approach to lipid lowering therapy for the subgroup of very high-risk patients with an acute coronary syndrome is discussed separately. (See "Low density lipoprotein-cholesterol (LDL-C) lowering after an acute coronary syndrome".)

DEFINITIONS

Risk groups — Patients with established cardiovascular disease (CVD) include those with stable or unstable coronary artery disease, ischemic stroke, transient ischemic attack, or peripheral arterial disease. Prevention of CVD events in these high-risk individuals is referred to as secondary prevention.

There is a spectrum of risk among individuals with CVD. We consider the CVD individuals with the following characteristics to be at very high risk:

Acute coronary syndrome within the past year (See 'ACS patients' below.)

                     

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Literature review current through: Jul 2017. | This topic last updated: Jul 25, 2017.
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