Cholesterol redux

Article Abstract:

Medical evidence that lowering blood cholesterol levels is important for preventing coronary heart disease (CHD) is now stronger than ever before, and significant public health efforts are underway to encourage better cholesterol management. The entire December 19, 1990 issue of The Journal of the American Medical Association is devoted to the topic of hypercholesterolemia (high blood cholesterol levels). Results from several studies indicate that, however achieved (with drugs or diet), lowering blood cholesterol levels leads to improvements in the health of blood vessels, even in people who already have atherosclerosis (fatty plaques accumulated on arterial walls). In such cases, the rate of disease progression is slowed. Lowering cholesterol also reduces the rate of formation of early lesions. Familial defective apolipoprotein B-100 is a disorder that affects as many as 1 in 500 people in the United States, causing premature CHD. Three articles in this Journal issue focus on cholesterol in childhood, a time when atherosclerosis is believed to begin. Whether children should be routinely screened for high blood cholesterol is discussed. The number of visits to physicians for monitoring cholesterol levels increased by a factor of nine in the 1980s, and cholesterol-lowering drugs are currently prescribed at a fast clip. Such agents can be expensive, and costs vary considerably, depending on which drug is selected. The price can discourage patients and physicians from using this treatment approach, but such drugs should be seen as adjuncts to a comprehensive cholesterol-lowering program, which should also include dietary change and blood pressure control. Studies indicate that, under fear of death, the overweight American can improve his high-fat diet. Tendencies to live better in this regard may be aided by improvements in food labeling, better school lunches (planned in California, at least), and the use of less saturated fat in fast foods. Overall, improvements in cholesterol awareness testify to the importance of conscious health promotion, under the strong leadership of the medical profession. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Coronary heart disease, editorial

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Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease

Article Abstract:

Considerable attention has been paid to the association between blood cholesterol levels and the development of heart disease, but less is known about the progression of heart disease in men with different cholesterol levels. This issue was addressed as part of a 10-year study of 2,541 white men, aged 40 to 69, in three cardiovascular disease categories (heart attack, abnormal results on an exercise test, or other symptoms) and a no-disease control category. Baseline information was gathered at the start of the study regarding the subjects' blood cholesterol levels and other relevant factors, including smoking. Results showed that previous myocardial infarction (heart attack) increased the risk of death from coronary heart disease (disease of the coronary arteries, which supply blood to the heart muscle) more than 20-fold. The risk of death increased as lipid levels (with which cholesterol is associated) increased for men with and without cardiovascular disease at baseline. Subjects with higher blood cholesterol levels (more than 6.19 millimoles per liter) had a risk of death from cardiovascular disease that was approximately three and one-half times greater than that of men with cholesterol levels below 5.16 millimoles per liter. Men with cardiovascular disease at baseline had higher rates of death from cardiac causes than men without disease. In addition, during the study period, as cholesterol levels increased from 'desirable' to 'high' among men with preexisting disease, the risk of death from cardiovascular disease increased from 3.8 percent to almost 19.6 percent. For men without baseline cardiovascular disease, this risk increased from 1.7 percent to 4.9 percent. Overall, the findings indicate that men with evidence of cardiovascular disease and high blood cholesterol should receive aggressive treatment to reduce their cholesterol levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiovascular diseases, Mortality, Patient outcomes, Statistics, Prognosis

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The value of lowering cholesterol after myocardial infarction

Article Abstract:

Considerable research has associated elevated levels of cholesterol in the blood with increased risk of heart attacks. Current recommendations are to lower cholesterol by dietary means, exercise and drugs. Although these recommendations have been predominantly associated with the reduction of risk in patients who have not yet experienced a heart attack, the same advice should be applied to all patients, including those who have already had a heart attack. Unfortunately, many patients with heart conditions do not receive cholesterol-lowering therapy. When a patient has heart diseases, the risk of his sustaining a heart attack is 5 to 7 times greater than for a patient without evident heart disease. Although some research has shown that the risk of heart attack in coronary patients with elevated cholesterol levels is less than for individuals who have not had a heart attack, other reports indicate similar risks for both groups. In any case, even if the relative risk is reduced, the absolute risk of a heart attack associated with elevated cholesterol levels remains high. There has been concern that the effects of lowering cholesterol have not been to reduce mortality overall, but this finding may be related to the lack of power of the statistical analysis that was employed. There remains a need for preventive action to lower cholesterol levels in patients who have previously survived a heart attack. Two thirds of all coronary disease patients have cholesterol levels above 5.17 mmol per liter; current recommendations are that these patients should establish a goal of 5.17 mmol per liter or lower. Patients should be treated to a therapy that includes elimination of smoking, cholesterol reduction, and treatment of hypertension (elevated blood pressure). (Consumer Summary produced by Reliance Medical Information, Inc.)

Heart attack

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