Treatment of dyslipidemias

To summarize recommended treatment strategies for various dyslipidemias.

The basic pathways of lipoprotein metabolism are reviewed, and the potential for interventional alterations to correct specific dyslipidemias is outlined. Guidelines for treatment based on published clinical trials, including the consensus report of the National Cholesterol Education Program, are discussed.

The nonpharmacologic options of diet and exercise are important elements in the treatment of dyslipidemias. In most patients, a reduced dietary intake of fat (particularly saturated fat) should be maintained for 3 months before drug therapy is initiated. The various mechanisms of action of the bile acid resins, niacin, hydroxy-methylglutaryl-coenzyme A reductase inhibitors, and fibric acid derivatives are described, and their roles in monotherapy or combination therapy for hypercholesterolemia, combined hyperlipidemia, and hypertriglyceridemia are examined.

With an understanding of the metabolic pathways responsible for the production and removal of lipoproteins and an overview of results of previous pharmacologic interventions, clinicians can optimize lipid-lowering treatment in individual patients with dyslipidemia.