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(Circulation. 1996;94:2351-2354.)
© 1996 American Heart Association, Inc.

Articles

Beyond LDL Cholesterol Reduction

H. Robert Superko, MD

Cholesterol, Genetics, and Heart Disease Institute and Berkeley HeartLab, San Mateo, and Lawrence Berkeley National Laboratory, Berkeley, Calif.

Correspondence to H. Robert Superko, MD, Cholesterol, Genetics, and Heart Disease Institute, 1875 S Grant St, Suite 700, San Mateo, CA 94402. E-mail superko@best.com. http://www.heartdisease.org.

Key Words: Editorials • cholesterol • lipoproteins

	Success of LDL-C Reduction

 
Within the past decade, clinical trials of LDL-C reduction have convincingly demonstrated that LDL-C reduction in primary and secondary prevention trials can significantly reduce clinical cardiac events.¹ Arteriographic investigations have demonstrated that LDL-C reduction can significantly reduce the rate of arteriographically defined disease progression.¹

	Failure of LDL-C Reduction

 
Despite the success of LDL-C reduction, close examination of the trial results reveals that a substantial number of subjects who received treatment and achieved significant LDL-C reduction still had a clinical event or evidence of arteriographic progression (Table 1). In the LRC-CPPT, for example, there was a 17% reduction in clinical events, which was made up of 187 events in the control group and 155 in the treatment group (32 fewer events). In SSSS, there was a 30% reduction in clinical events, which was composed of 622 events in the placebo group and 431 in the treatment group (191 fewer events). Although the reduction in clinical events is gratifying and laudable, it was not enough for the 155 subjects in the LRC-CPPT or the 431 subjects in SSSS who received treatment yet still had an event. The reason for such a large number of poor responders may lie in the prevalence of metabolic abnormalities linked to atherosclerosis that are not detected on routine laboratory tests and hence are not adequately treated with just LDL-C reduction.^{2 3} This issue also involves the concept of monotherapy, which takes on added importance with the report that multifactorial risk reduction reduces clinical events significantly more than single therapy.⁴

View this table: [in this window] [in a new window]   Table 1. . . . [Full Text of this Article]

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