Overview of current issues in management of dyslipidemia

An ever-increasing body of evidence supports active intervention in patients with dyslipidemia. Newly formulated recommendations call for evaluation of and treatment decisions based on not only total cholesterol and low-density lipoprotein (LDL) cholesterol levels but also high-density lipoprotein (HDL) cholesterol and triglyceride levels. HDL cholesterol determinations are now encouraged as part of routine coronary risk assessment in healthy adults. In addition, both HDL cholesterol and triglyceride measurements are recommended in patients with coronary artery disease, cardiovascular risk factors, or potentially atherogenic disorders such as hypertension or diabetes. If hygienic measures fail to normalize lipid values, a variety of drugs may be used. Future management strategies may include novel agents that inhibit different steps in lipid metabolism or in cholesterol biosynthesis, drugs that modify the lipoproteins themselves rather than change their concentrations, and drugs that protect the vessel wall from atherogenesis. A problem still to be resolved is that only about 10% of candidates for antihyperlipidemic drug therapy are receiving such treatment.