Lipid disorders: tailoring diet and drug therapy for individual needs

Treatment of hypercholesterolemia begins with a low-fat, low-cholesterol diet. In older patients, it is important that dietary measures do not compromise adequate intake of calories, calcium, sodium, and carbohydrates and do not exacerbate constipation. Drug therapy may be indicated if diet fails to achieve desired lipid levels. Bile acid binding resins, nicotinic acid, and HMG-CoA reductase inhibitors are effective for lowering LDL. Fibric acid derivatives are the most potent triglyceride-lowering agents. Depending on the drug prescribed, you may need to monitor liver function and watch for signs of myalgia. Constipation is also a common side effect of many of these drugs and may be minimized by increasing water intake or dietary fiber.