PREVENTION OF CORONARY HEART DISEASE AS THE GOAL
Atherosclerosis is the primary cause of coronary heart disease. Markedly lowering blood cholesterol can halt and even reverse to some extent the progression of atherosclerosis. For these reasons, prevention should be the goal, with the focus on decreasing elevated blood cholesterol. About 20% of Americans between 20 and 75 years of age have blood total cholesterol lev-els above 240 mg/dL, a level requiring management, and up to 40% of some middle aged groups have this elevation.
Although hypercholesterolemias are linked to spe-cific genetic mutations, most have a multifactorial basis that can respond to lifestyle changes. Even though the physician is justified in immediately prescribing a cholesterol-lowering drug to patients with very high blood cholesterol and additional risk factors, strong ad-vice should also be given on the need and benefits of adding life style changes. These changes include reduc-tion of body weight; decreased dietary total fat, choles- terol, saturated fatty acids, and trans fatty acids; and in-creased exercise and stress management. In fact, a re-cent study employing intensive lifestyle changes in pa-tients with coronary heart disease achieved a 37% lowering of LDL (low-density lipoprotein) cholesterol, a 91% decline in anginal episodes, and a decline in coro-nary artery stenosis within a year—all without drugs. A prescription for lifestyle changes should accompany the one for a hypocholesterolemic drug.