The slide on the left shows the natural course cardiovascular disease - a progressive disease manifesting as a recurring cycles of heart attacks and strokes. Without prevention,  The slide on the right shows the effect of optimal preventive treatment on the composition of the plague itself - arresting plaque progression and causing plaque stabilization.

 

The first landmark statin clinical trial was the 4S Study published in 1994. The most recent landmark clinical statin trial is the JUPITER Trial in 2008. Between 1994 and 2008, there were over a dozen clinical trials. Cumulatively, there are over 1 million patient-years of clinical trial data confirming repeatedly that statin reduces heart attacks, strokes, cardiac deaths, stents, heart bypass surgeries, hospitalizations, etc.

 

 

Successful prevention involves addressing all modifiable risk factors including adopting a healthier lifestyle. This means quitting smoke, healthier diet, more physical activity, blood pressure and diabetes control, in addition to lipid management. While all are important, the foundation is prevention in high risk patients is lipid therapy. Analysis of the STENO-2 trial showed that cholesterol treatment accounted for more than 70% of cardiovascular risk reduction.

 

Comparing stent therapy and optimal medical (cholesterol) therapy in patients with advanced but stable coronary heart disease - the COURAGE Trial. The conclusion at the end of the study was not surprising for NJ Preventive Cardiology and others who have successfully implemented aggressive prevention in clinical practice for many years. Click here for more.

 

Cholesterol problem can be simple or complex. Minimum treatment targets for high risk patients are LDL cholesterol less than 100 mg/dl (less than 70 mg/dl for very high risk patients), LDL particle number less than 1,000, non-HDL cholesterol less than 130 mg/dl, HDL cholesterol over 40 mg/dl for men and over 50 mg/dl for women and triglycerides less than 150 mg/dl. Treatment range from non-drug approach to single drug to combination drug therapy. Some treatment goals can been achieved in two months, some may take two years.

While treatment of any risk factor can slow down plague progression, only aggressive lipid therapy has been shown to reliably induce plaque regression. The above slide demonstrates the potency of advanced cholesterol therapy in inducing plaque regression after just three years of treatment.