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Published on: November 10, 2017
Management of dyslipidemia in adults
S M Ahmed1, M E Clasen, J E Donnelly
1Wright State University School of Medicine, Dayton, Ohio, USA.
Insights
National guidelines emphasize treating dyslipidemias based on cardiovascular risk. Treatment goals for low-density lipoprotein (LDL) cholesterol vary, from <160 mg/dL for primary prevention to <100 mg/dL for established coronary heart disease.
Area of Science:
- Cardiology
- Metabolic Disorders
- Preventive Medicine
Background:
- Dyslipidemias require treatment tailored to individual cardiovascular risk factors.
- National Cholesterol Education Program guidelines provide a framework for managing lipid disorders.
- Excluding secondary causes of hyperlipidemia is a critical initial step in patient evaluation.
Purpose of the Study:
- To outline treatment strategies for dyslipidemias based on cardiovascular risk assessment.
- To define target low-density lipoprotein (LDL) cholesterol levels for different patient groups.
- To review dietary and pharmacologic interventions for managing lipid disorders.
Main Methods:
- Risk stratification for coronary heart disease (CHD).
- Setting specific LDL cholesterol treatment targets based on risk level.
- Evaluation of dietary interventions (Step II diet, high-fiber diet).
- Review of pharmacologic treatments including bile acid resins, statins, nicotinic acid, and fibric acid derivatives.
- Consideration of alternative therapies like hormone replacement, plasmapheresis, and surgery for refractory cases.
Main Results:
- Treatment goals for LDL cholesterol are stratified: <160 mg/dL (one risk factor), <130 mg/dL (≥2 risk factors) for primary prevention.
- For patients with documented CHD, LDL cholesterol target is <100 mg/dL.
- Dietary modifications can contribute to achieving lipid targets.
- Pharmacologic options offer effective management for various dyslipidemias.
Conclusions:
- Cardiovascular risk assessment is paramount in guiding dyslipidemia treatment.
- Achieving target LDL cholesterol levels is crucial for preventing cardiovascular events.
- A combination of lifestyle modifications and pharmacotherapy is often necessary for effective dyslipidemia management.
Abstract:
The importance of treating dyslipidemias based on cardiovascular risk factors is highlighted by the National Cholesterol Education Program guidelines. The first step in evaluation is to exclude secondary causes of hyperlipidemia. Assessment of the patient's risk for coronary heart disease helps determine which treatment should be initiated and how often lipid analysis should be performed. For primary prevention of coronary heart disease, the treatment goal is to achieve a low-density lipoprotein (LDL) cholesterol level of less than 160 mg per dL (4.15 mmol per L) in patients with only one risk factor. The target LDL level in patients with two or more risk factors is 130 mg per dL (3.35 mmol per L) or less. For patients with documented coronary heart disease, the LDL cholesterol level should be reduced to less than 100 mg per dL (2.60 mmol per L). A step II diet, in which the total fat content is less than 30 percent of total calories and saturated fat is 8 to 10 percent of total calories, may help reduce LDL cholesterol levels to the target range in some patients. A high-fiber diet is also therapeutic. The most commonly used options for pharmacologic treatment of dyslipidemia include bile acid-binding resins, HMG-CoA reductase inhibitors, nicotinic acid and fibric acid derivatives. Other possibilities in selected cases are estrogen replacement therapy, plasmapheresis and even surgery in severe, refractory cases.
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