High cholesterol primary prevention: Difference between revisions
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'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Kashish Goel|Kashish Goel, M.D.]] | |||
Primary prevention is the most effective means of reducing the global burden of cardiovascular disease. NCEP recommends population-based and clinical-based approaches for primary prevention. Physicians should establish short-term and long-term goals for their patients based on risk factors and 10-year CHD risk. Two-step approach is preferred: | Primary prevention is the most effective means of reducing the global burden of cardiovascular disease. NCEP recommends population-based and clinical-based approaches for primary prevention. Physicians should establish short-term and long-term goals for their patients based on risk factors and 10-year CHD risk. Two-step approach is preferred: | ||
==Therapeutic lifestyle changes== | ==Therapeutic lifestyle changes== | ||
Revision as of 14:57, 10 September 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Kashish Goel, M.D. Primary prevention is the most effective means of reducing the global burden of cardiovascular disease. NCEP recommends population-based and clinical-based approaches for primary prevention. Physicians should establish short-term and long-term goals for their patients based on risk factors and 10-year CHD risk. Two-step approach is preferred:
Therapeutic lifestyle changes
Therapeutic lifestyle changes should be recommended to every individual to reduce long-term risk. These include cessation of smoking, dietary modifications, weight control and physical inactivity. A previous meta-analysis showed that dietary lowering of cholesterol was associated with CHD risk reduction similar to drug therapy[1]. A recent randomized controlled trial by Jenkins et al. showed that cholesterol lowering diets were associated with a significant reduction in LDL and 10-year CHD risk at 6 monhts, as compared to control diet[2].
LDL lowering drug therapy
LDL lowering therapy for primary prevention has been evaluated in numerous trials. If therapeutic lifestyle changes do not achieve the desired LDL goal, then drug therapy should be considered. Statins are usually the 'first choice' medications. Trials evaluating the role of statin therapy in primary prevention are detailed here.
- A recently published Cochrane meta-analysis including 14 randomized controlled trials (34,272 participants) showed a significant reduction in all-cause mortality, combined fatal and non-fatal CVD endpoints and revascularizations with statin therapy in subjects without cardiovascular disease. However, they reported heterogeneity of effects between studies[3].
- Another meta-analysis evaluating the role of statins in primary prevention of cardiovascular disease showed a significant reduction in major coronary events, major cerebrovascular events and revascularizations in 42, 848 participants, however no change in coronary heart disease mortality or overall mortality was noted[4].
References
- ↑ Gordon DJ.Cholesterol lowering reduces mortality:the statins. In: Grundy SM, ed. Cholesterol-lowering therapy: evaluation of clinical trial evidence. New York:Marcel Dekker Inc., 2000:299-311
- ↑ Jenkins DJ, Jones PJ, Lamarche B, Kendall CW, Faulkner D, Cermakova L; et al. (2011). "Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial". JAMA. 306 (8): 831–9. doi:10.1001/jama.2011.1202. PMID 21862744.
- ↑ Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP; et al. (2011). "Statins for the primary prevention of cardiovascular disease". Cochrane Database Syst Rev (1): CD004816. doi:10.1002/14651858.CD004816.pub4. PMID 21249663.
- ↑ Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK (2006). "Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials". Arch Intern Med. 166 (21): 2307–13. doi:10.1001/archinte.166.21.2307. PMID 17130382. Review in: J Fam Pract. 2007 Mar;56(3):174