Therapy of the hyperlipidemias

Although the diagnosis of hyperlipidemia is somewhat arbitrary, in that the upper limits of normal are not universally agreed upon, it is clear that the risk of atherosclerosis increases with plasma cholesterol concentration; it may also increase in hyperglyceridemia. We take 220 mg/100 ml as the upper limit of normal for plasma cholesterol and 140 mg/100 ml as the upper limit for triglycerides. Treatment of hyperlipidemia is aimed at reducing the risk of atherosclerosis or arresting its course. Alteration of diet is the first step. If maximal diet therapy does not lower plasma lipids to acceptable levels, drug therapy is added. The decision to treat hyperlipidemia with drugs should be based on a careful weighing of risk vs. benefit for each patient. Because of the rapid change in our knowledge of both the risks and the benefits of therapy, that decision must be reviewed and updated at regular intervals.