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The importance of treating patients to lower the cholesterol levels and to lessen the risk of developing atherosclerosis is well accepted. However, the question remains whether there is a threshold below which cholesterol reduction may translate into clinical benefit.

On average drug therapy with simvastatin loweres LDL cholesterol levels by 35% and reduces heart risk by 34% (Pedersen et al., 1998). The goal of this study was to reduce total cholesterol below 200. However, many patients achieved reductions greater than this and were associated with continuing but progressively smaller reductions in heart attack risk. This subgroup analysis estimated a 1% reduction in LDL, reducing the risk of major coronary events by 1.7%. However, at what point this benefit can be extrapolated to remains to be determined. Another active debate is whether the treatment for acute myocardial infarction in high-risk patients should be lipid-lowering therapy rather than revascularization (Forrester and Shah, 1997).

Additional therapeutic approaches that are receiving attention include antioxidant treatment such as vitamin E. In a situation where oxidation of LDL is a major target in atheroge-nesis, antioxidant therapy obviously might play a role. To what extent it may be of benefit is still under investigation.

Fundamental to the treatment of atherosclerosis is recognizing it as a systemic disease with the potential to affect a variety of end organs. Therefore, when patients are identified it appears advantageous to screen, counsel, and treat patients as soon as possible.

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