Introduction

© The risk of atherosclerosis is directly related to increasing levels of serum cholesterol. Hypercholesterolemia (elevation in serum cholesterol) and other abnormalities in serum lipids play a major role in plaque formation leading to coronary heart disease (CHD) as well as other forms of atherosclerosis, such as carotid and peripheral artery disease (atherosclerosis of the peripheral arteries). This predictive relationship has been demonstrated from large epidemiologic,1 animal, and genetic studies. CHD is the leading cause of death in both men and women in the United States and most industrialized nations. It is also the chief cause of premature, permanent disability in the U.S. workforce. Annually, approximately 700,000 Americans will suffer a new heart attack and 500,000 will have a recurrent event. The average age of a first heart attack is 66 years for American men and 70 years for women. The direct and indirect cost of CHD to the U.S. economy in 2007 was almost $151.6 billion. Clinical trials have consistently demonstrated that lowering serum cholesterol reduces atherosclerotic progression and mortality from CHD.

The development of CHD is a lifelong process. Except in rare cases of severely elevated serum cholesterol levels, years of poor dietary habits, sedentary lifestyle, and life-habit risk factors (e.g., smoking and obesity) contribute to the development of atherosclerosis. Unfortunately, many individuals at risk for CHD do not receive lipid-lowering therapy or are not optimally treated. This chapter will help identify individuals at risk, assess treatment goals based on the level of CHD risk, and implement optimal treatment strategies and monitoring plans.

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