Management of Dyslipidemias
The salient points related to diagnosis of dyslipidemias and advance beyond the National Cholesterol Education Program (NCEP) guidelines (1).
The revolutionary statins: the changes in management of dyslipidemia based on the proven effectiveness of statins in achieving goal low-density lipoprotein (LDL-C) levels and improvement in survival. In patients with coronary heart disease (CHD), statins result in an approximately 29% decrease in risk of cardiac death and about 20% decrease in total mortality. The decrease in the risk of mortality provided by statins is equal to that observed with angiotensin-converting enzyme (ACE) inhibitors, whereas the combined effects of estrogens, antioxidants, folic acid, vitamin E, and herbal remedies are insignificant, and their effects are unfairly exploited, to the detriment of patients who are thus deprived of proven mortality- and morbidity-reducing agents. It is not surprising, therefore, that τ;40% of individuals who require aggressive control of dyslipidemia are not receiving adequate treatment. Goal LDL-C must be achieved if we are to stem the plague of CHD.
LDL-C-HDL-C goal: Agents that decrease LDL-C to goal and also increase high- density lipoprotein (HDL-C) levels by τ;20% are ideal agents. Although fibrates significantly increase HDL-C, they only modestly decrease LDL-C and rarely achieve goal LDL-C levels. Fortunately, newer statins such as atorvastatin and rosuvastatin have been shown to decrease LDL-C by 40–50% and virtually always achieve goal levels except in patients with genetic familial hyperlipidemia.
KeywordsNational Cholesterol Education Program Scandinavian Simvastatin Survival Study Coronary Atheroma Scandinavian Simvastatin Survival Study Group Early Recurrent Ischemic Event
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