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Lipid Lowering Drugs and Hyperlipidaemia

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Summary

The clinician must go beyond measurement of the plasma cholesterol and think in terms of lipoproteins for the proper management of the patient with hyperlipidaemia.

Hyperlipidaemia is often secondary to various diseases and thus should be improved or eliminated if the underlying disease can be treated successfully.

The first step in the management of primary hyperlipidaemia (i.e. hyperlipidaemia not clearly attributable to another recognised disease) is its translation into hyperlipoproteinaemia, which can be done by measuring the fasting plasma cholesterol and triglyceride concentrations and noting the appearance of the plasma left overnight in a refrigerator at 4°C.

Diet is the basic element of all therapy for hyperlipidaemia. Although many diets may work in many types of hyperlipoproteinaemia, a specific diet for each primary or familial type is often more effective as well as more practical. In type II or type III it can be shown that diet and drugs are additive and more effective than either alone. Furthermore, the combination of both drug and diet may be required to normalise blood lipids.

Hypolipidaemic drugs are therefore used as a supplement to dietary control. Many are effective, but no drug works in all types of hyperlipoproteinaemia and all have side-effects. Cholestyramine is effective in type IIa. Clofibrate is extremely effective in type III; it may sometimes be useful in types IV and V, but, when not contra-indicated, nicotinic acid is usually more effective.

Since commitment to life-long therapy is not an easy burden, it is important to remember that the major reason for treating cholesterol, to decrease heart disease risk, is presumptive and unproved. It would seem prudent to recommend diet therapy for all patients with hyperlipoproteinaemia, but the use of drugs must be viewed with caution until it is conclusively proved that decreasing the concentrations of blood lipids will decrease the rate and risk of atherosclerosis. Clofibrate, or any of the other currently available hypolipidaemic drugs, is not therefore recommended for indiscriminate use in patients with angina or other forms of coronary artery disease.

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Authors and Affiliations

  1. Lipid Metabolism Branch, National Heart and Lung Institute, National Institutes of Health, Bethesda, Maryland, 20014, USA

    Robert I. Levy &  Basil M. Rifkind

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  1. Robert I. Levy
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  2. Basil M. Rifkind
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Levy, R.I., Rifkind, B.M. Lipid Lowering Drugs and Hyperlipidaemia. Drugs 6, 12–45 (1973). https://doi.org/10.2165/00003495-197306010-00003

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