WHY TREAT DYSLIPIDEMIA

Considerable observational clinical trial data have been collected con cerning abnormal lipid levels and coronary disease incidence over the past 20 years. Middle-aged men with elevated cholesterol levels have b een studied the most. Affected individuals tend to experience greatly increased risk for atherosclerosis and myocardial infarction. Bile aci d resins, nicotinic acid, fibrates, and statin therapies have all been associated with a decreased vascular disease incidence. In general, e ach percentage lowering in blood cholesterol level has been associated with a 2% lowering in coronary heart disease incidence over a 5-year follow-up interval. Complementary data from atherosclerosis regression trials have shown that-persons taking lipid lowering medication typic ally exhibit less progression of atherosclerotic lesions in coronary a nd carotid arteries. Less data is available concerning the efficacy of lipid lowering in women and the elderly, but observational data sugge st some benefit might be expected. Most clinical trials have emphasize d the importance of lipid intervention using medications, but dietary trials have also demonstrated efficacy, and current dietary recommenda tions call for middle-aged persons to consume less than 30% of their c alories as fat. While the impact of dyslipidemia on coronary heart dis ease has been emphasized, it is also important to recognize that contr ol of lipids may have long-term impact on other diseases, such as diab etes mellitus, carotid stenosis, and pancreatitis.