This Article Full Text Full Text (PDF) Correction Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Superko, H. R. Articles by King, S. Search for Related Content PubMed Articles by Superko, H. R. Articles by King, S., III Related Collections Secondary prevention Risk Factors Chronic ischemic heart disease Lipid and lipoprotein metabolism Related Article

(Circulation. 2008;117:560-568.)
© 2008 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Is lowering low-density lipoprotein an effective strategy to reduce cardiac risk?

Lipid Management to Reduce Cardiovascular Risk: A New Strategy Is Required

H. Robert Superko, MD; Spencer King, III, MD

From the Center for Genomics and Human Health, St Joseph’s Translational Research Institute, Atlanta, Ga.

Correspondence to H. Robert Superko, MD, FAHA, Executive Director, Center for Genomics and Human Health, St Joseph’s Translational Research Institute, 5673 Peachtree Dunwoody Rd NE, Ste 675, Atlanta, GA 30342. E-mail rsuperko@sjha.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

"It is not good to settle into a set of opinions. At first putting forth great effort to be sure that you have grasped the basics, then practicing so that they may come to fruition is something that will never stop for your whole lifetime. Do not rely on following the degree of understanding that you have discovered, but simply think...This is not enough."

— Hagakure, Yamamoto Tsunetomo, September 10, 1716 (a Samurai)1

For the past 22 years, substantial national efforts have been directed toward reducing the average blood low-density lipoprotein cholesterol (LDL-C) level of the American population. This initiative was initially prompted by the successful results of the Lipid Research Clinic–Coronary Primary Prevention Trial (LRC-CPPT), which first proved that reducing LDL-C resulted in a statistically significant reduction in cardiovascular events.² The intent of these efforts has been to reduce the human suffering and economic cost of cardiovascular disease. In the subsequent 2 decades, a plethora of monotherapy cholesterol-lowering drug trials has consistently reported a statistically significant 25% relative risk reduction for cardiovascular events. These findings form the basis for the current Adult Treatment Panel (ATP) III guidelines and the recent call to adjust the LDL-C goal even lower.³

Response by Grundy p 568

Although this level of success in the fight against heart disease is laudable, a great danger for our patients’ future health lies in the assumption that cholesterol reduction alone will stem the tide of coronary heart disease (CHD). It is wise and prudent to remember the . . . [Full Text of this Article]

Related Article:

Promise of Low-Density Lipoprotein–Lowering Therapy for Primary and Secondary Prevention

Scott M. Grundy
Circulation 2008 117: 569-573. [Extract] [Full Text]

This article has been cited by other articles:

				P. M Ridker, J. G. MacFadyen, F. A.H. Fonseca, J. Genest, A. M. Gotto, J. J.P. Kastelein, W. Koenig, P. Libby, A. J. Lorenzatti, B. G. Nordestgaard, et al. Number Needed to Treat With Rosuvastatin to Prevent First Cardiovascular Events and Death Among Men and Women With Low Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive Protein: Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) Circ Cardiovasc Qual Outcomes, November 1, 2009; 2(6): 616 - 623. [Abstract] [Full Text] [PDF]

				H. R. Superko Advanced Lipoprotein Testing and Subfractionation Are Clinically Useful Circulation, May 5, 2009; 119(17): 2383 - 2395. [Full Text] [PDF]

				N. F. Kelland and A. P. Roberts Letter by Kelland and Roberts Regarding Article, "Lipid Management to Reduce Cardiovascular Risk: A New Strategy Is Required" Circulation, August 12, 2008; 118(7): e119 - e119. [Full Text] [PDF]