New Guidelines and Clinical Tactics for Optimal Management of Dyslipidemia in Patients with or at Risk for Cvd*

Cardiovascular disease (CVD) is the leading cause of death in the United States as well as in other highly developed countries. It is also the leading cause of death in people with diabetes, a disease becoming rapidly more prevalent. This article reviews a series of clinical trials showing the benefits of lipid-lowering agents in reducing CVD risk. It also provides a review of the recent treatment guidelines, including the Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Pressure in Adults and focuses on the primary prevention in patients with multiple risk factors. Additionally, appropriate management of special populations is analyzed, including patients with the metabolic syndrome, elderly patients, those with low levels of high-density lipoprotein cholesterol, and those with coronary artery syndrome. Also analyzed is the risk assessment value of the high-sensitivity C-reactive protein assay in clinical practice. Overall, this article provides evidence that lipid treatment should be part of the overall approach to managing CVD risk factors. (Adv Stud Med. 2004;4(5A):S372-S381) N umerous preventive therapies have been shown to reduce cardiovascular disease (CVD) risk, and any approach to CVD prevention in high-risk patients should address all risk factors. The use of lipidlowering agents, statins in particular, to lower CVD risk substantively is well documented, and the number of patients who can benefit from therapy continues to expand as more clinical data accrues. This approach includes appropriate behaviors and therapies, such as a low-fat diet (with fats limited to omega-3 fatty acids), aerobic exercise, smoking cessation, blood pressure (BP) control, aspirin, and beta blockers. Including lipid-lowering agents in this composite approach has also proved to be of substantial help in preventing CVD progression and related events. A number of clinical trials have shown that the use of lipid-lowering agents should be a part of a multifaceted approach to CVD prevention.