Practical recommendations for the management of hyperlipidemia.

Hyperlipidemia is a risk factor for atherosclerosis. Raised low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) levels are severe risk factors for atherosclerosis. The role of high-density lipoprotein cholesterol (HDL-C) is controversial. Total cholesterol, LDL-C, HDL-C, triglycerides and lipoprotein(a) levels should be determined in a fasting state. The basis of treating hyperlipidemia remains diet, physical exercise and weight reduction. Olive oil and nuts have been shown to be beneficial. Statins remain first line drug treatment. Further treatment options are ezetimibe, bile acid sequestrants, fibrates and fish oil. Side effects of statins include myopathies and, as shown during the last years, also an increased risk of diabetes mellitus. In patients with statin-related myopathies first results of a gene analysis have been published showing a means of predicting which statin can be administered at which dose for the individual patient with least risk of side effects. Most convincing data have been shown for simvastatin. Patients with renal insufficiency have been shown to have a raised cardiovascular risk. In the SHARP Study the combination of simvastatin plus ezetimibe was effective in reducing cardiovascular events in patients with severe renal insufficiency (especially before dialysis but also in dialysis dependent patients). Important aspects of treating patients with chylomicronemia syndrome are illustrated. Treating young patients with hyperlipidemia as primary prevention remains problematic.