For patients who do not tolerate statins, LDL cho- lesterol lowering therapy with bile acid seques- trants,* niacin, or both is reasonable.502,504,505 (Level of Evidence: B) Epidemiological studies have established serum cholesterol as an important coronary heart disease risk factor. The Framingham Heart Study, Multiple Risk Factor Intervention trial, and the Lipid Research Clinics trials all found a continuous, graded increase in coronary events with increas- ing LDL cholesterol in men and women who were initially free of IHD.502,506 508 A similar relationship has been ob- served among patients with SIHD.509 511 The association between LDL cholesterol and cardiovascular risk is curvilin- ear, or log-linear, meaning that the decrease in RR for a given 1-mg/dL decrease in LDL cholesterol seems to be the same at any level of baseline LDL cholesterol. The principal lipid modification strategy recommended by the NCEP ATP-III (National Cholesterol Education Program Adult Treatment Panel III) in patients with SIHD is the reduction of LDL cholesterol.18,24 This should start with therapeutic lifestyle changes, including dietary therapy, daily physical activity, and weight management. Most patients also will benefit from cholesterol-lowering drug therapy, preferably with a statin. Effective dietary approaches to lowering LDL cholesterol include replacing saturated and trans fatty acids with dietary carbohydrates or unsaturated fatty acids and reducing dietary cholesterol. 