In my practice in the Lipid Clinic and Cardiovascular Risk Intervention Program at the University of Pennsylvania, I face daily decisions about whom to treat with cholesterol-lowering medication and how aggressively to reduce the cholesterol level. As stated in your article, the dilemma is, "How do we target effective but costly treatments to the people most likely to benefit?" The entire medical community is in agreement that virtually all persons with known coronary heart disease should be treated with medication, even if the cholesterol level is in the "average" range.
However, the decision to use cholesterol-lowering medication in apparently healthy persons is much more difficult. The key is in the accurate determination of who is and who is not likely to be at risk of a heart attack or cardiac death. Unfortunately, analysis of traditional risk factors for coronary disease is not sufficiently precise for the identification of high risk factors for individuals. Numerous "at risk" people will remain event free for decades, whereas a large number of heart attacks occur in subjects without major risk factors, most of whom have average or only mildly elevated cholesterol levels, cholesterol lowering methods.
Fortunately, there is a relatively new tool available which provides vital information about future risk of heart disease and can therefore be used in deciding whom to treat. The American Heart Association recently concluded that Electron Beam CT scanning for coronary artery calcification identifies the presence of coronary plaque and that this finding would influence the aggressiveness with which risk factor modification is approached.Extensive studies over the past eight years demonstrate that measurement of coronary calcification correlates with coronary disease and helps predict the likelihood of future clinical coronary events even in persons without any current symptoms, cholesterol lowering methods.
I now use this rapid, non-invasive test in selected individuals in order to assist in the important decision of whether to initiate cholesterol-lowering therapy. This technology for coronary artery scanning has become increasingly available across the country at a cost of less than a six-month prescription for cholesterol-lowering drugs. Combining the power of this non-invasive detection of coronary disease with the effectiveness of the statin drugs finally allows us to focus aggressive preventative treatment on those individuals with underlying coronary atherosclerosis who are at highest risk of having future heart attacks and coronary death, cholesterol lowering methods.
However, the decision to use cholesterol-lowering medication in apparently healthy persons is much more difficult. The key is in the accurate determination of who is and who is not likely to be at risk of a heart attack or cardiac death. Unfortunately, analysis of traditional risk factors for coronary disease is not sufficiently precise for the identification of high risk factors for individuals. Numerous "at risk" people will remain event free for decades, whereas a large number of heart attacks occur in subjects without major risk factors, most of whom have average or only mildly elevated cholesterol levels, cholesterol lowering methods.
Fortunately, there is a relatively new tool available which provides vital information about future risk of heart disease and can therefore be used in deciding whom to treat. The American Heart Association recently concluded that Electron Beam CT scanning for coronary artery calcification identifies the presence of coronary plaque and that this finding would influence the aggressiveness with which risk factor modification is approached.Extensive studies over the past eight years demonstrate that measurement of coronary calcification correlates with coronary disease and helps predict the likelihood of future clinical coronary events even in persons without any current symptoms, cholesterol lowering methods.
I now use this rapid, non-invasive test in selected individuals in order to assist in the important decision of whether to initiate cholesterol-lowering therapy. This technology for coronary artery scanning has become increasingly available across the country at a cost of less than a six-month prescription for cholesterol-lowering drugs. Combining the power of this non-invasive detection of coronary disease with the effectiveness of the statin drugs finally allows us to focus aggressive preventative treatment on those individuals with underlying coronary atherosclerosis who are at highest risk of having future heart attacks and coronary death, cholesterol lowering methods.
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