Practical Lipid Management: Concepts and Controversies

Practical Lipid Management: Concepts and Controversies PETER P. TOTH, M.D., PH.D. Director of Preventive Cardiology Sterling Rock Falls Clinic, Ltd. Chief of Medicine, CGH Medical Center Sterling, Illinois Clinical Associate Professor Departments of Family and Community Medicine University of Illinois College of Medicine Peoria, Illinois Southern Illinois University School of Medicine Springfield, Illinois

KEVIN C. MAKI, PH.D. President & Chief Science Officer Provident Clinical Research & Consulting, Inc. Glen Ellyn, Illinois and Bloomington, Indiana

A John Wiley & Sons, Ltd., Publication

Practical Lipid Management

Practical Lipid Management: Concepts and Controversies PETER P. TOTH, M.D., PH.D. Director of Preventive Cardiology Sterling Rock Falls Clinic, Ltd. Chief of Medicine, CGH Medical Center Sterling, Illinois Clinical Associate Professor Departments of Family and Community Medicine University of Illinois College of Medicine Peoria, Illinois Southern Illinois University School of Medicine Springfield, Illinois

KEVIN C. MAKI, PH.D. President & Chief Science Officer Provident Clinical Research & Consulting, Inc. Glen Ellyn, Illinois and Bloomington, Indiana

A John Wiley & Sons, Ltd., Publication

This edition first published 2008,  2008, John Wiley & Sons, Ltd. Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Other Editorial Offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Toth, Peter P. Practical lipid management : concepts and controversies / Peter P. Toth, Kevin C. Maki. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-05690-5 1. Hyperlipidemia – Treatment. 2. Coronary heart disease – Prevention. I. Maki, Kevin C. II. Title. [DNLM: 1. Dyslipidemias – therapy. 2. Cardiovascular Diseases – prevention & control. WD 200.5.H8 T717p 2008] RC632.H87T68 2008 616.3
997 – dc22 2008024773 ISBN: 978-0-470-05690-5 A catalogue record for this book is available from the British Library Typeset in 9/10.5 Times by Laserwords Private Limited, Chennai, India Printed in Great Britain by T.J. International Ltd., Padstow, Cornwall.

To the memory of my parents, Janos and Ilona Toth, who came to America from Hungary with hope, literally the shirts on their backs and unable to speak English. With much love and gratitude for all you endured and worked for to ensure a better life for me. Nagyon hi´anyzoltok nekem. Sok szeretettel. Peter P. Toth This book is dedicated to our children, Sarah and Miles. It is my sincere hope that they know a time when coronary heart disease is, like polio, a rare condition that has been relegated mainly to the annals of medical history. Kevin C. Maki

Contents

Foreword

xiii

Preface

xv

Acknowledgements

xix

Chapter 1 Epidemiology of Lipids, Lipid Management and Risk for Coronary Heart Disease: An Overview 1.1 Early History of Cardiovascular Epidemiology 1.2 Lipid Risk Factors are Central to Efforts at CHD Prevention 1.3 LDL-C and CHD Risk 1.4 LDL-C Lowering and CHD Risk Reduction 1.5 Other Atherogenic Lipoproteins: Atherogenic Remnants 1.6 HDL-C and CHD Risk 1.7 Trends in Lipids and Lipid Management in the USA 1.8 The National Cholesterol Education Program Evaluation Project Using Novel E-Technology (NEPTUNE) II Survey Controversy: Should a Measure of Atherogenic Lipoprotein Particle Number be used in Risk Assessment And/Or to Evaluate the Response to Lipid Therapy?

Chapter 2 Vascular Biology and Atherogenesis 2.1 Introduction 2.2 Arterial Structure 2.3 Endothelial Cell Function and Dysfunction 2.4 The Role of Monocytes and Lymphocytes 2.5 Atheromatous Plaques

1 2 3 4 6 7 9 10 10

12

19 20 20 21 24 25

viii

CONTENTS

Chapter 3 Detection, Evaluation, and Treatment Goals for Lipid Disorders in Adults 3.1 Matching Aggressiveness of Treatment to Absolute Risk 3.2 Screening for Dyslipidemias 3.3 Risk Stratification 3.4 Steps in the Risk Stratification Process – Major Risk Categories 3.5 Tips for Calculating the Framingham Risk Score 3.6 Subcategories for Consideration of More Aggressive Optional Treatment Goals 3.7 Very High Risk Patients, Optional LDL-C Goal