The Value of Lowering Cholesterol after Myocardial Infarction

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Abstract
CURRENT recommendations for lowering the cholesterol level to prevent coronary heart disease have focused largely on primary prevention and have paid less attention to the issue of lowering cholesterol in patients who already have coronary disease.1 2 3 4 5 6 It remains a common conception that in survivors of infarction the extent of myocardial damage is the prime determinant of outcome and serum cholesterol is not a major risk factor.7 The opposing view is that the modifiable risk factors after a myocardial infarction are the same as those before and merit treatment.8 , 9 In current practice, it appears that most patients with coronary disease do not receive cholesterol-lowering treatment.10 11 12 We review the relevant data from observational and clinical trials and conclude that cholesterol lowering should be pursued actively in most patients with coronary disease.