MANAGING ELEVATED BLOOD LIPID CONCENTRATIONS - WHO, WHEN AND HOW

Patients with elevated serum cholesterol concentrations, particularly men, should be treated to lessen their chance of subsequent morbidity from coronary heart disease. Reduction of elevated triglyceride levels is more contentious, but is justified in severely affected individuals. The levels requiring treatment can only be judged by consideration of the overall clinical setting, including patient age and sex, the presence of other risk factors and the particular lipoprotein abnormality. In general, relative youth, male sex, a low level of high density lipoprotein (HDL) cholesterol arid a strong family history of coronary heart disease will favour vigorous therapy. The ! possibility that hyperlipoproteinaemia is secondary to some other metabolic disorder should be considered, particularly in regard to elevated triglyceride levels. Appropriate dietary counselling plays a central role in the clinical management of the hyperlipoproteinaemias. If diet is unsuccessful in controlling lipid levels consideration should be given to the use of pharmacological agents. For isolated hypercholesterolaemia, appropriate choices include bile acid sequestering resins, nicotinic acid, fibric acid derivatives, HMG CoA reductase inhibition and probucol. Severely affected individuals may require combination therapy or the use of nondietary, nonpharmacological methods (e.g. plasmapheresis) for cholesterol reduction. For patients with predominantly elevated triglyceride levels fibric acid derivatives, nicotinic acid (niacin) and marine oils should be considered. © 1990, ADIS Press Limited. All rights reserved.