A lot of my patients wonder about the point of lowering cholesterol after a heart attack or other sign of heart disease. "Isn't it a waste of time?" they ask. The answer is an emphatic NO. Once you've had a heart attack, you're at a much greater risk of having another. Because the risk is higher, the treatment benefits are even greater. This statement isn't my medical opinion; it is one of the best-studied issues in all of medicine. The 1994 4S trial discussed earlier was the first to document the benefit of lowering choles- ,193
terol in patients who had preexisting heart disease, but even as recently as 2004, the PROVE-IT trial showed the benefit of lowering LDL to under 65 mg/dL in individuals with recent heart attack symptoms. (This was one of the studies that led the NCEP to add 70 mg/dL as an optional goal LDL level for people with heart disease.) In the decade that separated those two reports, many other studies that used a variety of statins have showed a benefit on either mortality or a new coronary event in patients with preexisting heart disease. So, if you have already had a heart attack, you should be even more aggressive about treating any lipid or other risk factor you have that would make it more likely for you to experience the same problem again.
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