ABSTRACT
The reality of regression of atherosclerotic plaques was established as long ago as
1987 by aggressive cholesterol reduction even before the era of statin therapy. Nevertheless,
the most important aspect of patient benefit to prevent cardiovascular (CV) disease
events is stabilization of these plaques so they will not rupture. Lowering of low-density
lipoproteins is critical to this goal and can be considered the gold standard of preventive
CV medicine. The major goal for the high-risk patient and the diabetic patient is
lowering these harmful lipoproteins to less than 70 mg/dL. No discussion of CV disease
prevention is complete without considering tobacco abuse and its elimination. Even
secondhand smoke has been established as harmful. Control of hypertension is another
major aspect of CV disease prevention, and a blood pressure less than 120/80 mm Hg
is ideal. With obesity a major problem in the developed world, its role in the metabolic
syndrome is of major significance as is the high prevalence of this so-called syndrome
versus collection of specific risk factors in a population with poor health habits.
Control of diabetes mellitus has established benefit from the standpoint of CV disease
prevention except that some problems have been reported with extremely tight blood
sugar control. Exercise was long considered good but now there are evidence-based
reasons to recommend it as essential in CV disease prevention. There are many unforeseen
frontiers in CV disease prevention but, for now, everything points to elevation of
high-density lipoproteins as the next focus of this prevention.
KEYWORDS
Atherosclerosis - coronary heart disease - peripheral vascular disease - cholesterol
- statins
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Thomas F. WhayneJr. M.D. Ph.D. F.I.C.A.
326 Wethington Building
900 South Limestone Street, Lexington, KY 40536-0200
Email: twhayn0@uky.edu
