Reducing atherothrombotic events in high-risk patients: recent data on therapy with statins and fatty acids.

Traditional treatment of atherosclerotic coronary heart disease by cardiovascular specialists, which has focused on "critical" stenoses, may be less effective in reducing morbidity and mortality than therapies that stabilize plaques and reduce thrombosis and sudden death. Recent data from clinical trials of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy and modification of dietary fat composition demonstrate that both these approaches can reduce clinical events. Although revascularization therapy is effective in reducing angina caused by high-grade stenotic lesions, this therapy is incomplete because the more-numerous "smaller" plaques that typically cause clinical events remain untreated. Two recent trials suggest that statin therapy may have benefits on stabilizing plaques in high-risk patients within a year. Additional benefit may also be provided by increasing dietary consumption of monounsaturated or omega-3 polyunsaturated fatty acids. Both statin therapy and diets high in monounsaturated or omega-3 fatty acids appear to improve morbidity and mortality by modifying the underlying atherothrombotic disease process.