Harder-to-Treat Patients: Recognizing Them and Adapting Treatment Strategies.
Despite significant progress in pharmacologic treatment aimed at lowering low-density lipoprotein cholesterol to reduce cardiovascular disease risk, a number of patient groups that often prove difficult to treat remain. Patients with familial hypercholesterolemia may go undiagnosed and untreated or, despite treatment, have persistently elevated lipid levels that confer a high cardiovascular disease risk. Although the true prevalence is unknown, statin intolerance is a common clinical presentation that is difficult to assess and frequently leads to suboptimal lipid treatment. Additionally, some patients may not achieve the expected response to guideline-based therapy. For all 3 groups, a standardized approach offers the best chance for effective diagnosis and optimal treatment.
Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota. Electronic address: mdm307@mail.harvard.edu.
Michael D
MD
Miedema
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Salim S
SS
Virani
D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000187:drug effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006938:Hyperlipoproteinemia Type II / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents