Pharmacologic Treatment of Dyslipidemia



Dyslipidemias are disorders of lipoprotein metabolism, including lipoprotein overproduction or deficiency. These disorders may be manifested by elevation of the serum total cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride concentrations, and a decrease in the high-density lipoprotein (HDL) cholesterol concentration.

Epidemiologic, angiographic and postmortem studies have documented a causal relationship between elevated serum cholesterol levels and the genesis of coronary heart disease. Angiographic studies show that aggressive cholesterol reduction by a variety of methods, as opposed to dietary modifications alone, results in increased rates of plaque regression and stabilization. Treatment with cholesterol-lowering drugs appears to be accompanied by a reduction in the lipid content of atherosclerotic plaques, thereby making them more stable and less prone to rupture. The Scandinavian Simvastatin Survival Study demonstrated a 30 percent reduction in total mortality in simvastatin-treated patients with coronary heart disease as compared with patients not receiving this agent. In a primary prevention trial, patients treated with pravastatin showed a 26 percent reduction in LDL cholesterol levels and a 31 percent reduction in coronary events (nonfatal myocardial infarction or death from coronary heart disease) as compared with the placebo group.

Even after recognizing the controversies surrounding cholesterol screening and therapy, most experts emphasize the importance of treating hypercholesterolemia. While guidelines for treating dyslipidemias may lack uniformity, much common ground exists for the management of dyslipidemias. The recommendations in this article are primarily based on the guidelines from the National Cholesterol Education Program (NCEP).

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