Treating Disease, Not Risk Factors

Quantitative measures of atherosclerosis, such as carotid intima–media thickness, are considered to be strong surrogate markers of disease progression. However, patients with hyperlipidemia are typically treated to target LDL and HDL levels, without regard to quantitative measures of plaque. In 2001, investigators at a vascular prevention clinic in western Ontario, Canada, began using the results of ultrasound measurement of total carotid plaque area, rather than lipid levels, to guide treatment in adults with known atherosclerotic disease. They compared their plaque-progression results through 2007 with those of the 5-year period before 2001, during which target lipid levels were used to guide treatment.

The investigators included serial pl…