[The pharmacological treatment of hypercholesterolemia]

Hypercholesterolaemia therapy should begin with implementation of a suitable diet in order to achieve optimum weight and reduce the intake of saturated fats. Often, however, a dietary regime is not sufficient to decrease cholesterol levels in hypercholesterolaemic patients and drugs must also be used. Some of the pharmacological options available act principally on LDL cholesterol, whereas others have more effect on triglyceride rich particle. HMGCoaA reductase inhibitors exert the greatest effect on plasmatic LDL cholesterol levels and are therefore recommended in cases of moderate or severe hypercholesterolaemia, particularly in the secondary prevention of ischaemic cardiopathy. Comparing the three statin drugs, lovastatin, pravastatin and simvastatin, the latter has recently been shown in study 4S to be effective in reducing global and coronary mortality in patients with a history of coronary heart disease. In addition to their action on LDL cholesterol, these drugs also increase HDL cholesterol, reduce triglycerides and have a beneficial effect on some of the fundamental mechanisms involved in the development of arteriosclerosis. Ion-exchange resins moderately reduce cholesterol levels, thus are used in young people or in combination with other drugs when a further reduction of LDL cholesterol is required. Their main drawback, however, is that they can often cause digestive intolerance. Primary prevention trials have shown that fibrates also reduce mortality by coronary heart disease but have no effect on global mortality. They are well tolerated and are used in the treatment of mixed hyperlipaemia. Other products, such as probucol and oestrogens, are also used but only under specific circumstances.