Identifying and managing patients with hyperlipidemia.
Cardiovascular disease related to hyperlipidemia is a significant cause of morbidity and mortality in the United States. The benefit of lowering lipid levels in patients with and without cardiovascular disease has been demonstrated in numerous clinical trials. The results of these trials prompted the National Heart, Blood, and Lung Institute to form the Nation Cholesterol Education Panel (NCEP). This panel developed guidelines for identifying and treating lipid disorders. Before starting antilipemic therapy, patients should be evaluated for secondary causes of hyperlipidemia, including disease states and medications. Risk factors for cardiovascular disease should be identified and used to determine the patient's goal low-density lipoprotein level. Regardless of the drug therapy used, the cornerstone treatment for hyperlipidemia is dietary changes. The NCEP recommendation for dietary modification follows a two-step plan to reduce intake of cholesterol and dietary fats. Other nonpharmacologic treatments for hyperlipidemia include exercise, weight reduction for obese patients, reduction of excessive alcohol use, and smoking cessation . Drug therapy should be considered in patients who do not respond to an adequate trial of dietary modifications and lifestyle changes. The principal lipid-lowering agents currently used are the bile acid sequestrants, nicotinic acid, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, and fibric acid derivatives. Estrogen, fish oil, and alcohol also can decrease the risk of developing heart disease. In pharmacoeconomic studies, lipid-lowering drug therapy has been shown to decrease the number of procedures, hospitalizations, and other medical interventions required by patients with cardiovascular disease.
Clark
A B
AB
Department of Pharmacy Services, Veteran's Affairs Medical Center, Memphis, TN, USA.
Holt
J M
JM
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004502:Education, Medical, Continuing; D004512:Education, Pharmacy; D005260:Female; D015438:Health Behavior; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014481:United States