Current and future trends in therapy for dyslipidemias.
OBJECTIVE
To characterize the atherogenic lipoprotein profile and discuss its implications in terms of treatment.


METHODS
Findings from large clinical trials and personal series of patients are reviewed, and the effectiveness of various interventions is assessed. A cost analysis of management of patients with dyslipidemias is offered.


RESULTS
The dyslipidemia associated with non-insulin-dependent diabetes mellitus (NIDDM) is similar to low-density lipoprotein (LDL) pattern B. This atherosclerosis susceptibility trait--which typically consists of a preponderance of small dense LDL particles, intermediate-density lipoprotein, slightly increased triglycerides, and inappropriately low high-density lipoprotein type 2-- tends to precede the actual diagnosis of NIDDM and to identify a group with increased risk for cardiovascular events. It also usually signifies a group with good responses to treatment, including arteriographic evidence of regression of coronary artery disease. In general, niacin and fibrates are superior to statins for treatment of patients with LDL pattern B. Lipid management has been proved to be a cost-effective treatment strategy.


CONCLUSIONS
Therapeutic options that lower triglyceride-rich lipoproteins and small dense LDL should be recommended in patients with NIDDM.
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Berkeley HeartLab and the Lawrence Berkeley National Laboratory, University of California, Berkeley, California, USA.