Cholesterol-Lowering Therapy in Patients With Coronary Heart Disease

Drug treatment to lower serum cholesterol should be based on a person’s risk of an ischaemic heart disease (IHD) event rather than initial cholesterol level. Any person who has had a myocardial infarction has about a 10% chance (without treatment) of dying from ischaemic heart disease in the following year and about a 5% chance of IHD death in each year thereafter. All such people (in the absence of contraindications to the specific drugs) qualify for HMG coenzyme A reductase inhibitor therapy (Statins) regardless of their cholesterol level.

There is a constant proportional relationship between serum cholesterol and disease risk, so any reduction in cholesterol level from any starting point leads to the same proportional reduction in IHD risk. Those people with the highest absolute starting risk (namely those with pre-existing IHD, such as this man who has had an AMI) stand to benefit the most.

Non-pharmacological means of serum cholesterol reduction are far less effective, and whilst important are inadequate in this patient.

Reference

• http://circ.ahajournals.org/content/95/6/1683.full