[Risk adapted therapy of vascular diseases--basic therapy of dys- and hyperlipoproteinemia]

Abstract

The target values in the treatment of patients with dys- and hyperlipoproteinemia are dependent on the underlying risk factors and the already existing vascular complications, respectively. The target value for patients with manifest vascular complications and for diabetics is <2.6 mmol/l (100 mg/dl) for LDL cholesterol. Results of recent studies show that in these high risk patients the target value for LDL Cholesterol should be </=1.8 mmol/l (70 mg/dl). Triglycerides should generally be lowered to <1.7 mmol/l (150 mg/dl) and HDL cholesterol should be >1.0 mmol/l (40 mg/dl). In high risk patients even higher HDL levels should be reached (men: >1,2 mmol/l (45 mg/dl), women: >1,4 mmol/l (55 mg/dl)). Basic therapy measurements of hyperlipoproteinemia are changes in diet, reduction of body weight and physical training after exclusion of contraindications. If the goals of therapy cannot be reached with these measures, drug therapy is indicated. In hypercholesterolemia the first choice are statins, which show the best data concerning endpoint studies. Other therapeutic options are ezetimibe, nicotinic acid derivates with retarded release marketed in Germany as Niaspan, fibrates and in single cases anion exchanger. In patients with hypertriglyceridemia fibrates are effective, but there exist very few endpoint studies for this substance group. Fish oils can also be used in this case. Mixed forms of hyperlipoproteinemia are the most difficult disorders to treat, in these cases the therapeutic decision should depend on whether the hypercholesterolemia or the hypertriglyceridemia is dominating.