IDENTIFYING AND MANAGING PATIENTS WITH HYPERLIPIDEMIA

Cardiovascular disease related to hyperlipidemia is a significant caus e of morbidity and mortality in the United States. The benefit of lowe ring lipid levels in patients with and without cardiovascular disease has been demonstrated in numerous clinical trials. The results of thes e trials prompted the National Heart, Lung, and Blood Institute to for m the National Cholesterol Education Panel (NCEP). This panel develope d guidelines for identifying and treating lipid disorders. Before star ting antilipemic therapy, patients should be evaluated for secondary c auses of hyperlipidemia, including disease states and medications. Ris k factors for cardiovascular disease should be identified and used to determine the patient's goal low-density lipoprotein level. Regardless of the drug therapy used, the cornerstone treatment for hyperlipidemi a is dietary changes. The NCEP recommendation for dietary modification follows a two-step plan to reduce intake of cholesterol and dietary f ats. Other nonpharmacologic treatments for hyperlipidemia include exer cise, weight reduction for obese patients, reduction of excessive alco hol use, and smoking cessation. Drug therapy should be considered in p atients who do not respond to an adequate trial of dietary modificatio ns and lifestyle changes. The principal lipid-lowering agents currentl y used are the bile acid sequestrants, nicotinic acid, 3-hydroxy-3-met hylglutaryl coenzyme A (HMC CoA) reductase inhibitors, and fibric acid derivatives. Estrogen, fish oil, and alcohol also can decrease the ri sk of developing heart disease. In pharmacoeconomic studies, lipid-low ering drug therapy has been shown to decrease the number of procedures , hospitalizations, and other medical interventions required by patien ts with cardiovascular disease.