[Modifying increased plasma cholesterol levels in secondary prevention of coronary heart disease].

In secondary prevention of coronary heart disease, the reduction of elevated cholesterol plasma levels is mainly based on diet and/or drugs. Invasive means such as partial ileal bypass operation or LDL-apheresis, although highly effective in reducing cholesterol levels and incidence of clinical cardiac events, should be reserved for special subgroups of patients. With dietary measures such as strict reduction of calories originating from fat, as well as with increased consumption of fish, fruits, vegetables and cereals, clinical or angiographic benefits could be demonstrated; in addition to the reduction of cholesterol plasma levels, other mechanisms such as inhibition of platelet aggregation and protection of LDL-particles from oxidation may contribute to this effect. With drugs reduction of cardiac events and of cardiac and total mortality was not observed in all clinical studies. Most angiographic drug studies revealed a significant, although quantitatively moderate retardation of the progression of coronary artery disease. However, only in a few studies did the clinical or angiographic effects correlate with the extent of changes in total, LDL- or HDL-cholesterol plasma levels or their absolute values on trial. Women and men seem to benefit equally from drug therapy. The efficiency of cholesterol-lowering measures in patients with age > 70 years is still unknown, however. In patients with coronary artery disease and normal cholesterol plasma levels neither clinical nor angiographic benefits could so far be demonstrated with cholesterol-lowering measures. Thus, to date in the secondary prevention of coronary artery disease cholesterol-lowering therapy with drugs only seems definitely indicated in patients < 70 years of age with hypercholesterolemia resistant to diet.