Volume 110, Issue s44

The role of low-density lipoprotein cholesterol (LDL-C) in the pathogenesis of atherosclerosis is well recognized. Recent research has documented the importance of inflammation in atherosclerosis formation and disease progression. Lowering LDL-C with HMG-CoA reductase inhibitors (“statins”) has been shown to decrease atheroma burden and reduce cardiovascular adverse events in patients with acute coronary syndromes as well as in asymptomatic patients with recognized risk factors. In addition, recent primary prevention studies have shown that aggressively lowering LDL-C with statins—even in people with so-called “normal” LDL-C and few cardiovascular risk factors—can substantially reduce the rate of myocardial infarction, stroke, and other cardiovascular outcomes. The impact of treatment is particularly notable in patients with elevated levels of C-reactive protein, a recognized marker of vascular inflammation.

Traditional risk factor assessments for coronary heart disease (CHD) often fail to take into account individual factors such as race and lipid profiles that may substantially elevate a patient's risk for CHD or a cardiovascular event. Although numerous treatment guidelines have been issued on metabolic syndrome, discrepancies among the guidelines can create confusion. Cardiac biomarkers and imaging methods have emerged to help detect and quantify subclinical atherosclerosis, but many of these are not proven as cost-effective for use in clinical practice or for routine screening. As the present case-based activity demonstrates, determining appropriate diagnostic and management strategies according to CHD risk is a process that challenges physicians to consider myriad individual patient variables.