Lipid management: tools for getting to the goal

The treatment of hypercholesterolemia in the United States begins with the recognition of elevated low-density lipoprotein cholesterol (LDL-C) as the primary target. An optimal LDL-C level has been defined as < 100 mg/dL. The first step in lowering LDL-C continues to be lifestyle modification, which includes a restriction of saturated fat and cholesterol, increased physical activity, and weight loss, if applicable. Approximately half of all patients with elevated LDL-C levels will ultimately need treatment with a lipid-lowering drug to achieve treatment goals. The preferred drug for first-line treatment in most patients is a statin; a bile acid resin or niacin can be used in patients who cannot tolerate statins or who are not candidates for stain therapy. Combination therapy is an option, with several combinations showing efficacy in lowering LDL-C (statin plus bile acid resin, niacin plus bile acid resin) and in lowering both LDL-C and triglycerides (statin plus fibrate, statin plus niacin, bile acid resin plus niacin). Successful lipid management includes treating to reach the LDL-C goal level, treating to reach the non-high-density lipoprotein cholesterol goal level if applicable, and managing other risk factors for coronary heart disease.