Treatment of Elevated Cholesterol
Benjamin M. Scirica, MD; Christopher P. Cannon, MD What Is Cholesterol?
lesterol can lead to cholesterol deposits Cholesterol is a fatty substance that cir- structural component of all human cells.
“good” and a “bad” cholesterol. High cholesterol, the “bad” cholesterol, are associated with an increased risk of heart How Do Cholesterol Levels
Predict Risk?
tein (HDL) cholesterol, the “good” cho- with elevated total cholesterol are at an programs to reduce cholesterol levels.
after a blood test is the sum of all types in the Unites States, this issue affects 1 of cholesterol, as discussed in a previous Cardiology Patient Page (http://circ.
e296).3 Triglycerides are another form of What Problems Can
sons who are not “patients”) will help Cholesterol Cause?
The body requires some cholesterol to The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice or treatment, and the American Heart Association recommends consultation with your doctor or healthcare professional.
From the TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass.
Correspondence to Dr Benjamin Scirica, TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA (Circulation. 2005;111:e360-e363.)
2005 American Heart Association, Inc.
Circulation is available at
DOI: 10.1161/CIRCULATIONAHA.105.539106
Scirica and Cannon
Treatment of Elevated Cholesterol
Cholesterol-Lowering Medications
*Dietary-supplement niacin must not be used as a substitute for prescription niacin, and over-the-counter niacin should be used only if approved and monitored by a physician.
Data adapted from Physician’s Desk Reference, 2004, and JAMA. 2005;293:43.
heart attack increases by almost 20%.
imized or eliminated from your diet.
addition to their effects on cholesterol, statins have other beneficial effects.
the right treatment, both are measured.
in most people to control cholesterol.
( h t t p : / / h i n . n h l b i . n i h . g o v / a t p i i i / Drug Treatment of Cholesterol
Lifestyle Changes to
Lower Cholesterol
ate the statin because of side effects.
These other drugs include ezetimibe, the intestines and lowers LDL; nico- lesterol. Statins are the most common tinic acid (niacin), which lowers LDL and raises HDL; and fibrates, which saturated fats and trans-fatty acids (a e362
May 31, 2005
Overview of Current Recommendations From the National Cholesterol Education Program
Very high risk: ACS, or CHD with DM, multiple CRF High risk: CHD or CHD risk equivalents (10-year risk greater than 20%) if LDL is less than 100 mg/dL Moderately high risk: at least 2 risk factors Moderate risk: at least 2 risk factors (10-year risk Definitions: ACS indicates acute coronary syndrome (heart attack or acute cardiac chest pain); CHD, coronary heart disease; and DM, diabetes mellitus. CRF indicates cardiac risk factors: smoking, high blood pressure (blood pressure more than 140/90 or patient is taking medications), low HDL cholesterol (less than 40mg/dL), family history of early heart disease, and age (men older than 45 years; women older than 55 years). CHD risk equivalents are peripheral vascular disease,abdominal aortic aneurysm, and carotid artery disease, diabetes, or at least 2 cardiac risk factors.
Adapted with permission from Circulation. 2004;110:227.
Clinical Trial Evidence
and a different statin may be tried.
heart disease but at risk of future heart likely to cause side effects, but even in had heart disease, higher doses of statins 30 minutes before the nicotinic acid.
death, recurrent heart attacks, or severe New Frontiers
quires more individualized treatment.
How Low Should My
Cholesterol Be?
Side Effects
Glossary of Terms in
Cholesterol Treatment
Cholesterol: A fatty substance that Scirica and Cannon
Treatment of Elevated Cholesterol
2. Toth PP. The ‘good cholesterol’: high- density lipoprotein. Circulation. 2005;111:e89 – e91. Available at: http://circ.ahajournals.
3. Birtcher KK, Ballantyne CM. Measurement of cholesterol: a patient perspective. Circu-lation. 2004;110:e296-e297. Available at: High Blood Cholesterol In Adults (AdultTreatment Panel III). JAMA. 2001;285: presenter.jhtml?identifierϭ3000416.
5. Ridker PM. C-reactive protein: a simple test to help predict risk of heart attack and stroke.
Circulation. 2003;108:e81– e85.
Statins: Statins are the most com- Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM, Pravastatinor Atorvastatin Evaluation and Infection son’s age, sex, blood pressure, choles- terol, and smoking. Available at: http:// Infarction 22 Investigators. Intensive versus ● C-reactive protein (CRP): CRP is moderate lipid lowering with statins afteracute coronary syndromes. N Engl J Med.
7. LaRosa JC, Grundy SM, Waters DD, Shear Acknowledgment
C, Barter P, Fruchart JC, Gotto AM, Greten This manuscript underwent independent re- view by Dr Patrick O’Gara, who reports no Treating to New Target (TNT) Investigators.
Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N EnglJ Med. 2005;352:1425–1435.
8. Grundy SM, Cleeman JI, Merz CN, Brewer References
Web Resources
HB Jr, Clark LT, Hunninghake DB, PasternakRC, Smith SC Jr, Stone NJ. Implications of 1. Cholesterol Statistics on the American Heart recent clinical trials for the National Cholester- Association web site. http://www.american- ol Education Program Adult Treatment Panelϭ536.
III guidelines. Circulation. 2004;110:227–239.


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