Management of dyslipidaemias

Atherosclerotic disease is the leading cause of death among men and women in Europe, the United States, and worldwide.1,2 Previously considered a “western” disease, it is now clear that various peoples of diverse ethnic backgrounds are vulnerable to atherosclerosis. The epidemic of obesity, especially abdominal obesity, escalates the need for appropriate detection and management of high risk individuals. The overwhelming consumption of economic and medical resources necessitates preventive measures in order to decrease the global burden of heart disease. The recent Interheart study, a very large case–control study of acute myocardial infarction in 52 countries, demonstrates that traditional risk factors for coronary heart disease (CHD) account for most of the risk worldwide (over 90%) and include abnormal lipids, smoking, diabetes, hypertension, abdominal obesity, psychosocial factors, diminished consumption of fruits and vegetables, lack of regular alcohol intake, and lack of regular physical activity. The two most potent risk factors worldwide are smoking and dyslipidaemia.3 The forefront of primary and secondary prevention of CHD is the management of dyslipidaemia. This article will review current strategies in managing dyslipidaemias, focusing on drug treatment and the adjunctive role of diet. A lipid profile including total cholesterol, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides should be checked in all adults beginning at age 20, but earlier if the patient is obese or there is a family history of premature atherosclerotic disease or primary lipoprotein abnormalities (table 1). Elevated apo-B values may be a more accurate indicator of atherosclerotic risk than LDL alone. However, current guidelines base treatment on LDL values. European guidelines advocate use of the SCORE model and risk charts4 while US guidelines advocate use of the Framingham risk model and implementation of National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) guidelines based on …