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Controversies in Lipid Management

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Dr Devendra Prasad Singh, Bhagalpur    06 January 2018

  1. In contrast, Mediterranean diet consistently lowers CV events without lowering cholesterol level.
  2. Framingham studies have shown association of high cholesterol and triglycerides with CVDs. It has been argued that association does not mean causation and many trials show that statins are no good; hence, the controversies.
  3. Statins are not without side effects; 30% patients taking statins have muscle aches and rarely rhabdomyolysis. Long-term statin therapy causing T2DM and dementia, further questions the utility of statin therapy.
  4. Recent controversy is regarding dosing approach. Fixed-dose-treatment vs. titrating-to-target level neither of these approaches is inferior.
  5. CAD is an extremely complex malady. Until the controversies of cholesterol hypothesis vs. alternate mechanism of pathogenesis of atherosclerosis are settled, statin therapy will stay along with healthy lifestyle, Mediterranean diet and aspirin in the prevention of CVDs.

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