An urgent matter-identifying your patients' cardiovascular risk and improving their outcomes. Low-density lipoprotein cholesterol and coronary heart disease: the importance of reaching target goals with statin therapy

Abstract

While Managing Acute-Care Issues, family physicians are challenged daily to recognize and treat modifiable risk factors for coronary heart disease (CHD) and to educate patients on the importance of risk reduction. Time constraints and the imperatives of immediate issues make the challenge of identification and treatment of CHD risk difficult. A stunning number of family medicine patients present with 1 or more of the following CHD risk factors: low-density lipoprotein cholesterol (LDL-C) =130 mg/dL (33% of American adults), total cholesterol =200 mg/dL (45%), hypertension (33%), tobacco use (21%), sedentary lifestyle (69%), excessive body weight (body mass index =25; 67%), diabetes (8%), or pre-diabetes (26%). The objective of comprehensive therapeutic interventions in CHD, from diet and lifestyle changes, to smoking cessation, to medications, is to prevent new (primary prevention) or recurrent (secondary prevention) cardiovascular events, with the ultimate goal of preventing disability and death. Family physicians have the distinct advantage of seeing patients' health status from a global perspective, giving them a greater opportunity to recognize risk and initiate preventive interventions. Although therapeutic efforts have been directed traditionally at patients with established CHD and asymptomatic patients at high risk for cardiac events, new data are emerging that suggest that earlier, more aggressive treatment increases clinical benefit. This article (1) reviews the importance of reaching target goals for LDL-C and other biomarkers of risk in the primary and secondary prevention of CHD, and (2) addresses dosing issues and other practical methods of identifying and treating family medicine patients who are at risk.