Lipid-regulating and antiatherosclerotic therapy: current options and future approaches
DONALD G. VIDT, MD
ANTONIO M. GOTTO, MD, DphilAddress reprint requests to A.M.G., Department of Medicine, Baylor College of Medicine, 6550 Fannin, Suite 1423, Houston, TX 77030.
Increased understanding of the mechanisms of cholesterol-lowering therapy and other lipid risk factors has suggested new potential strategies for preventing and treating coronary heart disease (CHD). Although these new strategies hold promise, our first, best strategy for reducing the toll of CHD is to use current guidelines for treating dyslipidemia and other risk factors.KEY POINTS
Investigators have identified characteristics of rupture-prone lesions that may underlie 80% to 90% of all CHD events. Current evidence suggests that lipid-altering therapy stabilizes lesions, inhibiting plaque rupture. New drugs might inhibit cholestrol biosynthesis at a step other than that mediated by HMG-CoA reductase inhibitors. Another approach might be to alter the activity of enzymes or proteins that regulate lipoprotein metabolism. Angiotensin-Converting enzyme (ACE) inhibitors, calcium-channel blockers, and beta-adrenergic blockers have all shown indications of antiatherosclerotic activity unrelated to any lipid-regulating activity. Few conclusions can be drawn about what role antioxidant therapy will ultimately have. Although genetic strategies may prove ideal for treating individuals with severe genetic disorders, they are likely to be less useful in most of the population, in whom environmental factors are the predominant determinants of CHD rates.