Prevention of coronary artery disease: a medical imperative

Article Abstract:

The development of cardiology as a discipline has led to many innovations in the treatment of heart diseases. Technological advances such as coronary artery bypass surgery (bypassing blocked vessels), coronary artery angioplasty (re-opening blocked heart vessels surgically), and the use of thrombolytic drug therapy (drugs that dissolve clots) have been shown to be effective procedures which prolong life. However, it may be wise to question why there is such a great incidence of heart disease in the world, and whether this is necessary. Some of the underlying risk factors for coronary heart disease are difficult or impossible to modify. Family history of heart disease, being male, and aging are all known risk factors which are not modifiable by new patient behaviors. Other factors such as the blood level of cholesterol, smoking, physical activity level, and obesity are to a large degree modifiable by changes in lifestyle. At the core of the issue is the biologic process which leads to the accumulation of fatty plaques inside the blood vessels. Research has not conclusively shown that this process is reversible when environmental risk factors such as obesity, inactivity, and smoking are eliminated. But coronary heart disease is a product of affluent lives, and a disease that can be greatly reduced by behavior change. Physicians should be actively concerned with improving patients' understanding of these risk factors and motivating them to make the changes that lead to better health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention

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Treating hypercholesterolemia: how should practicing physicians interpret the published data for patients?

Article Abstract:

Large amounts of research data concerning cholesterol are prompting many physicians to employ generalized treatments for persons with moderately elevated blood cholesterol (hypercholesterolemia). A common approach is the use of drugs that lower blood lipid (fat) levels, however, the level of blood cholesterol at which patients should begin therapy is not known. Although hypercholesterolemia is a factor contributing to coronary artery disease (CAD), physicians are uncertain about how much effort should be expended on this risk factor as opposed to treating other known risk factors, such as obesity, stress, smoking, high blood pressure and lack of exercise. When designing a treatment plan for patients at risk for CAD, both physician and patient should consider other appropriate interventions (e.g, reduction of high blood pressure). While dietary change can contribute to greater patient participation in the treatment program than drug therapy alone, patients view drug therapy as a powerful means of overcoming medical problems. However, asymptomatic patients (those not having symptoms of CAD) should be informed that there is a correlation between cholesterol levels and CAD and that the benefits of drug therapy to control and lower blood cholesterol levels remain speculative. Further, the relation between blood cholesterol levels and mortality rates may be more complex than were previously believed.

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Management of hypercholesterolemia: are preventive interventions advisable?

Article Abstract:

Reduction of hypercholesterolemia (high blood cholesterol) is a popular method for reducing the risk for coronary artery disease (CAD). Although it is important to treat persons considered at high risk for CAD, these patients constitute only 10 percent of the US population and account for 20 percent of deaths due to CAD. The remaining population accounts for the other 80 percent of those dying from CAD. Therefore, it is important to direct treatment strategies at those who are not identified to be at high risk for CAD. Elevated cholesterol levels are just one of several risk factors for CAD; others include cigarette smoking, high blood pressure, lack of physical activity, high levels of dietary fat intake and obesity. Some persons may be at risk primarily due to factors beyond their control, such as genetic predisposition to high blood cholesterol levels. More than 35 percent of all adults between the ages of 20 and 74 years of age are suitable candidates for advice on improving cholesterol levels. Fundamental changes in behavior, such as quitting cigarette smoking, are the least costly and most effective means for individuals to reduce their risk of CAD. Physicians should continue to advise patients to limit total dietary fat intake. However, if diet alone is unsuccessful, drug therapy may be required.

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