Hyperlipoproteinemias: Part III. When to treat

The recommended treatment goals for patients with hypercholesterolemia who do not have coronary heart disease or two additional risk factors, are a total cholesterol of less than 240 mg/dL and an LDL-cholesterol of less than 160 mg/dL. For patients with coronary heart or two additional risk factors, the goals are 200 mg/dL and 130 mg/dL respectively. The step-one diet is the initial therapy for hypercholesterolemia, followed by the more rigid step-two diet if response has been inadequate. Drug treatment is indicated upon failure of adequate response to six months of dietary therapy, and an LDL-cholesterol of greater than or equal to 190 mg/dL in the patient without coronary heart disease or two additional risk factors, or greater than or equal to 160 mg/dL in the patient with coronary heart disease or two additional risk factors. The decision regarding when to treat patients with hypertriglyceridemia is controversial. Patients with levels greater than 500 mg/dL should at least be treated by diet. A consensus report on the management of children with hyperlipidemia is awaited. The approach to the elderly patient is debated.