Practical approach to the patient with hyperlipidemia

The National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP) guidelines reviewed in Chapter 2 provide an excellent evidence- based foundation for the management of hyperlipidemia. Using a consistent stepwise approach leads to better patient outcomes. All portions of the lipid profile are important to consider when assessing risk of cardiovascular disease, but it is prudent to first focus on optimizing low density lipoprotein (LDL). Most studies have proven the significant benefits of reducing LDL. Triglycerides (TG) and high density lipoprotein (HDL) are important, but they are secondary targets of therapy. An important exception is the patient with triglycerides greater than 500 mg/dl. In these patients, triglycerides should be reduced first to lower the risk of pancreatitis. Also, unless the LDL is directly measured, a very high triglyceride level makes the measurement and interpretation of LDL cholesterol difficult.