Pocket Science Lipids 2nd edition
Dr Jonathan Morrell
- The UK has one of the highest rates for death from CHD amongst developed countries and there is enormous scope for more effective intervention to reduce CHD.
- All risk factors must be taken into account when assessing a patient’s overall risk profile for CVD. Correction of blood lipid abnormalities is one aspect of intervention.
- Raised cholesterol, in particular LDL-C, is a pivotal risk factor in the development of CHD. Modern guidelines call for lifestyle modification and pharmacotherapy to reduce total cholesterol below 4 mmol/L and LDL-C below 2 mmol/L in high-risk patients.
- Reduction of LDL- C should be the primary target for lifestyle and therapeutic interventions. In addition, low levels of HDL-C and raised levels of triglycerides appear to be independent risk factors for the development of CHD; it is therefore important to assess the entire lipid profile in order to evaluate cardiovascular risk appropriately.
- Interventions that reduce LDL-C have been shown to reduce cardiovascular morbidity and mortality. Although lifestyle modifications are an important component to reduction of cardiovascular risk, pharmacological interventions are usually necessary to reduce LDL-C to target levels. A number of lipid-lowering agents are currently available. Drug regimens containing statins have become first-line therapy on the basis of demonstrable efficacy in achieving surrogate endpoints such as lowering LDL-C levels, reducing mortality and morbidity, and
with good tolerability. - Responsibility for the management of lipid disorders has clearly shifted to primary care in recent years. Key elements of effective patient management include:
- identification of patients with a high global cardiovascular risk
- treatment according to national guidelines
- achievement of target LDL-C and cholesterol goals.
- The development and implementation of appropriate systems of care will help ensure that targets are met and long-term compliance is achieved.