Benecol - Healthcare Professionals

Practical Approach to Elevated Cholesterol

The basic principle of lowering cholesterol is that indication and intensity of treatment is directly related to the degree of risk for CVD events. Both the short-term (5-10 years) and the long-term (lifetime) risk must be considered for treatment decisions. Persons with existing CHD or CHD risk equivalent are at the highest risk. For this reason, they receive the most intense treatment. For persons without CHD, classification and treatment goals are based on risk categories. Prevention strategies can be divided into those which apply to everyone and those which are necessary for selected groups. A healthy diet, physical activity and cessation of smoking are the strongest factors in prevention. These are fundamentals and apply to everyone.

Global CVD Risk Assessment

The importance of identifying presymptomatic individuals who will develop early and accelerated vascular disease has led to the development of numerous global CHD risk assessment tools. The most commonly used method for estimating risk of future CHD is based on the Framingham study and provided by the Third Report of the National Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) 2001. An alternative approach is provided by the joint European cardiovascular societies. These guidelines recommend a new model for total risk estimation based on the SCORE system, which is derived from a large data set of prospective European studies and predicts any kind of fatal atherosclerotic endpoint (i.e., fatal CVD events over a 10-year period). Estimation of risk should be broadly used and clinical decisions should be made taking into account age and gender as well as any history of prior CHD, PVD, stroke, diabetes mellitus, obesity, physical inactivity, smoking, blood pressure and/or lipid levels along with a medical family history, particularly of premature CHD, diabetes, hypertension and hyperlipidaemia. Individuals with established CHD are at very high risk for future CHD events. Therefore, formal risk assessment is not needed.

Therapy Based on Risk Assessment

The guiding principle in preventing future CVD events is adjusting indication and intensity of therapy to the individual's absolute CHD risk. Based on epidemiological and interventional clinical trials, LDL-C remains the primary target in prevention and treatment of CVD. LDL-C goals and cutpoints for therapeutic lifestyle changes (TLC) and drug therapy are defined according to four different risk categories. For further information, please consult the international or national guidelines for your country.