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(Circulation. 2004;110:3509-3511.)
© 2004 American Heart Association, Inc.

Editorial

Atherosclerosis Imaging and the Future of Lipid Management

Scott M. Grundy, MD, PhD

From the Center for Human Nutrition and the Department of Internal Medicine, University of Texas Southwestern Medical Center, and the Veterans Affairs Medical Center, Dallas.

Correspondence to Scott M. Grundy, MD, PhD, Center for Human Nutrition (Y3-206), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9052. E-mail scott.grundy@utsouthwestern.edu

Key Words: Editorials • atherosclerosis • lipoproteins • statins • trials

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

Lowering low-density lipoproteins (LDL) by statin therapy to reduce the risk for major clinical events in patients with established atherosclerotic cardiovascular disease (ASCVD) represents a therapeutic triumph of modern medicine. With standard doses of statins, the risk for CVD events falls by approximately one third.¹ Additional risk reduction occurs by adding other therapeutic modalities to statin therapy—antiplatelet drugs, antihypertensive agents, smoking cessation, and healthy lifestyle changes.² Most of the benefit from these combined treatments appears to result from the stabilization of vulnerable plaques in patients who have advanced atherosclerotic disease; in other words, they reduce the likelihood of plaque ruptures that cause acute cardiovascular syndromes.

See p 3512

Although novel nonlipid therapies may well be developed in the future, persistent aberrations in lipid metabolism in the face of standard doses of statins remain attractive targets of therapy. Two of these potential lipid targets are residually elevated low-density lipoprotein cholesterol (LDL-C) and atherogenic dyslipidemia. Additional LDL lowering can be achieved either by yet higher doses of statins or by combining standard doses of statins with other LDL-lowering drugs (eg, bile acid sequestrants or ezetimibe). Atherogenic dyslipidemia consists of elevations of serum triglycerides, apolipoprotein B, and small LDL particles plus low levels of high-density lipoprotein cholesterol (HDL-C).¹ Alternative therapies for atherogenic dyslipidemia available for combination with statins include fibrates and nicotinic acid.¹

For many patients with ASCVD, enhanced LDL lowering beyond that obtained with standard doses of statins may further reduce CVD events. Current guidelines for cholesterol management in these patients set . . . [Full Text of this Article]

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Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: A Double-Blind, Placebo-Controlled Study of Extended-Release Niacin on Atherosclerosis Progression in Secondary Prevention Patients Treated With Statins

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Circulation 2004 110: 3512-3517. [Abstract] [Full Text]