| |
The latest report from the National Cholesterol Education Program has reaffirmed that the primary lipid goal for the prevention of atherosclerotic vascular disease (AVD) is to achieve a normal low-density lipoprotein (LDL) cholesterol (<130 mg/dL) by diet in normal individuals, and by diet and statin therapy in patients with multiple risk factors. Patients with any clinical AVD (which includes diabetes) will need a statin to achieve an optimal LDL cholesterol (<100 mg/dL). The recent Heart Protection Study might revise our thinking further. Patients at high risk achieved a reduction in mortality and vascular events taking simvastatin 40 mg, even if they had a low baseline LDL value. Individuals with the metabolic syndrome and insulin resistance do not typically have a very high LDL, but rather have elevated triglycerides and a low high-density lipoprotein (HDL) cholesterol. They, too, need to be treated with a statin, first to achieve an appropriate LDL goal. This is insufficient if the triglyceride value exceeds 200 mg/dL. They should be treated to achieve a non-HDL cholesterol goal (equal to total cholesterol minus HDL cholesterol) that is 30 mg/dL higher than the LDL goal.
|
|
