Cholesterol management in patients with heart disease. Emphasizing secondary prevention to increase longevity.

Advances in treatment of elevated cholesterol levels and recent documentation of efficacy and safety in clinical trials justify expanded use of cholesterol-lowering therapy in clinical practice. Patients with CHD or other forms of clinical atherosclerotic disease can benefit from aggressive cholesterol management. Maximal dietary modification, weight control, and physical activity are valuable adjuncts to drug therapy in secondary prevention. Recent studies have shown that appropriate use of cholesterol-lowering drugs is cost-effective and efficacious in patients with CHD. Use of such drugs can increase patients' life expectancy. Primary care physicians have a key role in instituting intensive cholesterol management in patients with clinically manifest atherosclerotic disease. Furthermore, they should take the lead in coordinating with cardiovascular specialists to manage cholesterol levels in patients who have had a recent acute coronary syndrome or undergone a revascularization procedure.