[Goals and practical implementation of lipid therapy in coronary heart disease]

Abstract

In all patients with coronary heart disease a fasting lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) should be obtained. Hyperlipidemias can then be classified as hypercholesterolemia (LDL cholesterol elevated), mixed hyperlipidemia (LDL cholesterol elevated, triglycerides elevated) and hypertriglyceridemia (triglycerides elevated). Primary goal of lipid intervention is a LDL cholesterol < 100 mg/dl, secondary goals are HDL cholesterol > 35 mg/dl and triglycerides < 200 mg/dl. These goals can be reached by dietary intervention alone (reduction in fat and modification of fat intake) or in combination with lipid lowering drugs. Monotherapy with HMG-CoA reductase inhibitors or combined therapy with bile acid sequestrants will allow a reduction in LDL cholesterol by more than 50%; in predominant hypertriglyceridemia fibrates or nicotinic acid will lower triglycerides and elevate HDL cholesterol.