Book Review
Medical Management of Atherosclerosis
N Engl J Med 1998; 339:1170October 15, 1998
- Article
Medical Management of Atherosclerosis
(Clinical Guides to Medical Management.) Edited by John C. LaRosa. 326 pp. New York, Marcel Dekker, 1998. $135. ISBN: 0-8247-0149-6This year marks the 50th anniversary of the National Heart, Lung, and Blood Institute and of the American Heart Association. These organizations have contributed enormously to the research that has demystified atherosclerosis. We have moved from an era in which clinicians could only shrug their shoulders helplessly and wait for the infarction to an era in which we know with certainty that our interventions with respect to major risk factors — hypercholesterolemia, hypertension, and cigarette smoking — are saving lives. A book with the title Medical Management of Atherosclerosis would probably have been greeted with ridicule in 1948; in 1998, it represents a distillate of the extensive basic and clinical investigation that has given clinicians the tools with which to work.
Edited by John C. LaRosa, an outstanding clinical investigator in his own right, the book deals with a full array of established risk factors. LaRosa's chapter summarizes basic lipid metabolism and then takes readers logically through the currently recommended approaches to controlling hyperlipidemia. Separate chapters address hypertension and smoking and other lifestyle risks. These chapters include brief but scholarly reviews of the evidence implicating these risk factors in atherosclerosis, possibly at the expense of more practical instruction for the clinician. Later chapters, on the other hand, are decidedly “how to” chapters. A detailed discussion of cost effectiveness is very pertinent, and I hope it will be read by those who manage health maintenance organizations as well as by front-line practitioners. Additional chapters cover topics that are under active investigation but do not yet qualify as “treatment” (such as antioxidants and gene therapy), but sophisticated clinicians will want to know what may be coming down the pike.
At 326 pages, this book on atherosclerosis will be read in its entirety only by very serious practitioners. On the other hand, in the chapters dealing with established risk factors, practitioners will find valuable suggestions on its management.
Daniel Steinberg, M.D., Ph.D.
University of California, San Diego, La Jolla, CA 92093-0682
