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Lipid lowering to delay the progression of coronary artery disease
  1. Michael D Feher
  1. Correspondence to:
    Dr Michael Feher, (Lipid Clinic) Beta Cell Diabetes Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK;

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There is now substantial evidence from outcome trials, in individuals who have clinically manifest coronary artery disease (CAD), confirming the benefits of treating plasma lipids as one of the key factors in retarding the progression of clinical atherosclerotic disease. Over the past decade there have been an increasing number of clinical trials which have evaluated lipid lowering treatments, confirming the pathophysiological and epidemiological associations between plasma lipids and the progression of artery disease. CAD is demonstrated by angiographic confirmation of coronary artery lumen narrowing and has its clinical manifestations (coronary heart disease—CHD) as angina, unstable angina, myocardial infarction or revascularisation procedures such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG).

While acknowledging the important public health message of risk factor modification, in particular lipid lowering, for the primary prevention of CHD, this review covers the secondary prevention of CHD by focusing on the role of lipid lowering (that is, the treatment of total and low density lipoprotein (LDL) cholesterol, serum triglycerides, and high density lipoprotein (HDL) cholesterol) in delaying the progression of the clinical and angiographic findings in patients with clinically manifest CHD.

This review is divided into three parts: background evidence; treatment thresholds and targets for secondary prevention of coronary heart disease; and practical management issues.


The clinical importance of secondary prevention of CHD is highlighted by the observation in the secondary prevention trials that cardiovascular events account for 75% of the observed mortality in individuals with existing coronary disease.1 A pronounced increase—up to 20 fold—in coronary death over a 10 year follow up was observed when there is a history of CHD,2 compared to an individual without a history of CHD. The increased risk parallelled the degree of cholesterol elevation.

The major lipid alterations associated with the progression of coronary artery …

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