Diagnosis and management of lipoprotein abnormalities.
Abnormal lipid and lipoprotein cholesterol values have been defined as a low-density lipoprotein (LDL) cholesterol (C) value of 160 mg/dL (4.1 mmol/L) or greater, a high-density lipoprotein (HDL) C value less than 40 mg/dL (1.0 mmol/L), triglycerides (TG) 150 mg/dL (1.7 mmol/L) or greater, and a lipoprotein (a) (Lp(a)) of 30 mg/dl or greater. Such values all increase coronary heart disease (CHD) risk. The National Cholesterol Education Program Adult Treatment Panel III guidelines continue to focus on optimizing LDL-C values (established as < 100 mg/dL or 2.6 mmol/L), especially in those with established CHD, diabetes, or a 10-year CHD risk over 20%. Dietary saturated fat (< 7% of calories) and cholesterol (< 200 mg/day) restriction, and the use of 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are the mainstays of treatment in this regard. Such treatment substantially reduces CHD risk. Severe hypertriglyceridemia (> 1000 mg/dL or 11.0 mmol/L) is associated with pancreatitis, and fat restriction, control of glucose, and fibrate therapy are indicated in such patients. Niacin is currently the most effective agent for lowering Lp(a) and raising HDL-C. Current recommendations for treatment by diet and drugs are outlined.
Lipid and Heart Disease Prevention Clinic, Tufts-New England Medical Center, Lipid Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA.
Marcelo C
MC
Batiste
Ernst J
EJ
Schaefer
D000328:Adult; D000367:Age Factors; D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis* / Q000628:therapy*; D006951:Hyperlipoproteinemias / Q000175:diagnosis* / Q000628:therapy*; D015228:Hypertriglyceridemia / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL