This patient has no coronary artery disease but does have two risk factors. She should be advised on dietary modification. Target LDL cholesterol for her would be <130 mg/dL. Drug therapy would not be recommended unless the level was greater than 160 mg/dL. Moderate amounts of ethanol would not be appropriate given her already normal HDL.
The recommendations to begin dietary therapy is supported by meta-analysis of nine randomized trials for assessing the effects of cholesterol lowering with dietary and/or drug therpy as primary or secondary prevention of coronary artery disease events in women; this analysis showed that there remains no evidence that lowering cholesterol affects total mortality in women.
Here are the current NCEP guidelines:
- Walsh JM, Grady D. Treatment of hyperlipidemia in women. JAMA 1995; 274:1152-8.
- Hunick MG, Goldman L, Tosteson AN, et al. The recent decline in mortality from coronary heart disease, 1980-90. JAMA 1997; 277:535-42.
- Johnnesson M, Jonnson B, Kjekshus J, Olsson AG, Pederson TR, Wedel H. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med. 1997; 336:332-6.
- Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel II). JAMA 1993; 269:3015-23.
- Scandinavian Simvastatin Survival Study Group. Randomized trialof cholesterol lowering in 4,444 patients with coronary heart disase. The Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344:1383-9.
- Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD. Cholesterol reduction yields clinical benefit. A new look at old data. Circulation 1995; 91:2274-82.
- Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333:1301-7.