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Professor Dr. Dale Adler MD, prominent cardiologist and medical heart disease treatment expert, and Dr. Anton Titov MD PhD MBA / Exclusive interview on medical therapy for coronary heart disease, high cholesterol and hypertension treatment, and sudden death prevention and treatment.

- How to lower cholesterol? Let's discuss treatment of high cholesterol. High cholesterol level is a major risk factor for coronary heart disease. Recently the clinical guidelines for use of statins have changed. Statins are major drugs to lower cholesterol. Revision of statin use guidelines generated controversy in medical community. Under the new guidelines a number of people who should use statins to lower cholesterol have increased. But many people do not make full use of non-pharmacologic methods for lower cholesterol: the lifestyle changes, better food, and dietary changes. How do you approach the management of risk factors for coronary heart disease in your practice? Since early 1980s we have learned that LDL cholesterol is the bad cholesterol Any lifestyle modifications and any medications that specifically lower the level of LDL cholesterol - almost always there is a benefit to the patient. It seems that the lower you make LDL cholesterol level - the lower the risk of coronary artery disease. Can LDL cholesterol be too low? If LDL cholesterol is too low - can this create a problem? This has been a controversial issue. Probably too low level of LDL cholesterol is not really in issue for most people. We are not so worried that LDL cholesterol is going to be too low. For patients who do not have very high risks for coronary heart disease, we would love to see them work on improving their lifestyle. No questions about that. Who has low risk profile for coronary heart disease? #1: Those people who do not have a family history of very premature coronary artery disease. #2: Those who do not have diabetes. #3: Those who never had any heart-related health event whatsoever. But lifestyle change is a tough proposition. Relatively few people can keep their weight just where it should be. Few people can exercise on a regular basis and have very good diet. Let's now look at people who have already had a heart-related health problem, who have diabetes, who have a strong family history of premature coronary artery disease. In my clinical practice I support healthy diet and lifestyle changes. This is all terrific. But diet and lifestyle lowers LDL cholesterol in these people by only about 5%. Medications, the statins, often lower cholesterol by 20% to 40%. Medications and lifestyle / dietary changes are synergistic. So it's wonderful to put them together. So I say to my patients: "Let's make it very low. Let's drive it down." The recent clinical guidelines on the use of statins to lower cholesterol are controversial in several areas. One controversy is about the dose of statins to treat patients. Also there is controversy about evidence Dr. Dale Adler, MD: I agree very much with the guidelines when they say: "If you're going to use the statin to lower cholesterol, use statin in a dose that was used in the clinical trial". For example, simvastatin is a very nice medication to lower cholesterol. In the clinical trials simvastatin was used at 40 milligrams But a lot of physicians prescribe simvastatin at 5 milligrams or 10 milligrams per day. I say: "If it's worth treating a patient with a statin medication, then start medication in a dose that was established and shown to make a big difference." If the patient has trouble tolerating statin at that dose, then you may have to decrease the dose of medication. That even occurred in some of the clinical trials.


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