[Risk adapted therapy of vascular diseases--basic therapy of dys- and hyperlipoproteinemia]

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Context:

• Dys- and hyperlipoproteinemia management requires individualized target values based on risk factors and vascular complications.
• Current guidelines recommend specific lipid targets for high-risk patients, including diabetics and those with manifest vascular disease.

Purpose:

• To outline current therapeutic target values for low-density lipoprotein (LDL) cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol in patients with dys- and hyperlipoproteinemia.
• To review foundational lifestyle modifications and pharmacological interventions for managing hyperlipoproteinemia.

Summary:

• Target LDL cholesterol levels are <2.6 mmol/l for general patients and <1.8 mmol/l for high-risk individuals. Target triglycerides are <1.7 mmol/l, and HDL cholesterol should be >1.0 mmol/l (higher for high-risk patients).
• Initial management involves diet, weight reduction, and exercise. Pharmacotherapy, including statins, ezetimibe, nicotinic acid derivatives, fibrates, and anion exchangers, is indicated if lifestyle changes are insufficient.
• Statins are the first-line treatment for hypercholesterolemia due to robust endpoint data. Fibrates are effective for hypertriglyceridemia, though endpoint data is limited. Fish oils are an alternative for hypertriglyceridemia. Mixed forms require tailored treatment based on the predominant lipid abnormality.

Impact:

• Provides clear therapeutic targets for clinicians treating dys- and hyperlipoproteinemia, aiding in risk stratification and treatment selection.
• Highlights the importance of lifestyle modifications as a cornerstone of therapy, preceding or complementing drug interventions.
• Offers a comprehensive overview of pharmacological options, emphasizing statins for hypercholesterolemia and fibrates/fish oils for hypertriglyceridemia, guiding treatment decisions for complex lipid disorders.