[Pharmacologic therapy of hyperlipoproteinemia and its pitfalls]

Hyperlipoproteinaemias, in particular those associated with hypercholesterolaemia are considered one of the most significant risk factors for the development of early atherosclerosis and ischaemic heart disease. Effective reduction of plasma lipids and lipoproteins is associated with a decline in the prevalence of ischaemic heart disease and cardiovascular mortality. Pharmacotherapy of hyperlipoproteinaemias is therefore considered a rational procedure in preventive cardiology. After a brief review of comprehensive treatment of hyperlipoproteinaemias the author discusses in particular contemporary possibilities of their medicamentous treatment. He emphasizes hypolipidaemic agents most frequently used at present, i. e. statins, resins and fibrates. When selecting hypolipidaemic agents several basic data must be taken into account: values of the lipid metabolism, the effect of the hypolipidaemic agent on individual parameters, undesirable effect of the drug, tolerance on the part of the patient, as well as whether after prolonged treatment regression of atherosclerosis or a decline in the prevalence of ischaemic heart disease was recorded. Decision taking is influenced also in a major way by the price of the preparation. The author discusses therefore also the effectiveness of hypolipidaemic agents in relation to their price. On these data the basic recommendation for pharmacotherapy of hyperlipoproteinaemias is based. The author discusses in more detail some controversial problems of treatment of hyperlipoproteinaemias, treatment of children, women and old patients. Attention is devoted also to patients with isolated low HDL-cholesterol levels and patients with elevated triglyceride levels.