ABSTRACT
Dyslipidemia contributes substantially to the development and clinical expression of atherosclerosis, especially in the coronary Circulation [1-10]. Considerable evidence suggests that cholesterol lowering stabilizes atherosclerotic plaques and reduces CHD events, including all-cause mortality [11-37]. Those at highest risk of recurrent CHD events, notably diabetics and subjects with pre-existing CHD benefit the most from cholesterol lowering [16-21,128-129,132]. Angiographic or ultrasound trials of hypolipidemic therapy have shown a reduction in disease progression with aggressive compared with moderate treatment [38-95]. Large primary and secondary prevention event trials have demonstrated significant reductions in cardiovascular events in patients with a wide range of cholesterol levels [96-133]. These findings suggest that aggressive lipid management can accomplish the same treatment goals as traditional antianginal and interventional therapy, specifically reductions in anginal frequency, exercise intolerance, CHD events, and mortality [14,120-122,125-129,132,134]. This chapter reviews the pathophysiology and impact of hypolipidemic therapy on atherosclerosis [135-172] and vascular biology [173-241] and outlines the lipid management for coronary artery disease patients [242-337], including those undergoing interventional procedures.
