Lipid management for patients with CAD, Part 1: What to expect, when to start. Consider an aggressive strategy for prevention of cardiac events
In patients with established coronary artery disease (CAD), therapy to lower serum low-density lipoprotein (LDL) levels can halt the progression of atherosclerosis; it may also permit disease regression and improve endothelial function. Clinical trials have shown that aggressive lipid management can prevent cardiac events. In addition, lipid-altering medications have effects on endothelial function that may contribute to their preventive efficacy. The first steps in management are to measure serum lipid levels on at least 2 occasions and to identify and treat secondary causes of hyperlipidemia. Therapy should begin with dietary measures but escalate rapidly if necessary to include appropriate hypolipidemic agents. For most patients with established CAD (including those with 'normal' baseline LDL levels), lipid-lowering therapy with both diet and drugs is recommended.