[Drug therapy of hyperlipidemia--unanswered questions]

The use of lipid-lowering drugs is now established clinical practice. However, not all patient categories have been covered in the landmark studies (4S, WOSCOPS and CARE), leaving the arena open for widely differing opinions. Dyslipidoemia in patients with diabetes mellitus and arteriosclerotic disease of the aorta, limb arteries or carotid arteries should be corrected. The benefit remains unproven for patients with coronary artery disease and normal lipid levels, and for the elderly. Omega-3 supplements are approved in Norway for hypertriglyceridoemia, but clinical benefit has not been established for this treatment, in contrast to treatment with gemfibrosil. Hormone replacement therapy for postmenopausal women effectively lowers LDL cholesterol levels and the results of randomised studies with clinical endpoints are awaited. The rapid effect (within six months) of lowered cholesterol on coronary events suggests that starting treatment during middle age is adequate for many patients, except for those with familial hyperlipidemias.