Management of hyperlipidaemia: guidelines of the British Hyperlipidaemia Association

Abstract

There is considerable evidence to suggest that the identification and treatment of dyslipidaemia will reduce the risk of premature CHD, i.e. before the age of 65. Diagnosis of the cause of raised plasma lipid levels will enable appropriate decisions to be taken with regard to management. The cornerstone of treatment is nutritional counselling and attention to other major risk factors for CHD, particularly smoking and hypertension. For a small percentage of patients with severe hyperlipidaemia drug therapy is indicated. Appropriate drug choices need to be made based on the particular lipid abnormality to be treated. In general those patients with clinical vascular disease are treated more aggressively than those where the aim is primary prevention. More research is needed to determine individual risk more precisely and to allow proper targeting of therapy. Genetic factors, qualitative changes in lipoproteins, lipoprotein (a), fibrinogen, and other coagulation and thrombotic factors are likely to be important in individual risk assessment. There is no doubt that more information is needed from prospective studies of lipid-lowering therapy in terms of risk benefit for affected individuals. Hopefully the major studies currently underway will fill some of the gaps in our knowledge. Until then aggressive therapy with drugs should be reserved for those at highest risk where the benefit is likely to be greatest.

The effect of a low-fat, high-carbohydrate diet on serum high density lipoprotein cholesterol and triglyceride

“…Given that coronary disease continues to be a leading cause of morbidity and mortality in developed countries, the reduction of serum cholesterol concentrations has become a major public health objective, and the target for both individuals and populations is a cholesterol concentration of 5.2 mmolal (Assmann, 1990;Bettridge et al, 1993;Mann et al, 1993;NCEP Expert Panel, 1993). The individual, or high risk approach, targets those with the highest blood cholesterol concentrations; however, because a small proportion of the population falls into this category the overall impact on coronary heart disease mortality is relatively small.…”

Changes in blood pressure and lipids associated with rural to urban migration in Tanzania

“…Lowdensity lipoprotein (LDL) cholesterol was estimated using the Friedewald formula 5 for triglyceride values in mmol/l. 6 Two hundred and nine migrants (103 men) and 209 non-migrants (103 men) were recruited. Data are presented here on the 156 (76 men) and 170 (79 men), respectively (P-value on sex difference, 0.579), on whom follow-up was achieved at 6 months.…”

Coronary Risk Analysis - A Stitch in Time

“…As clusters of coronary risk factors may have a multiplicative effect, an individual with a Table 2 number of modest coronary risk factors may be at considerably greater risk than a subject with very high single risk factor [14], which can be assessed by calculating absolute risk over a period of next 5 or 10 years for an individual. In a survey undertaken by British Cardiac Society, it was observed that the risk factor recording and management was less than optimal <q1d there is considerable potential to improve secondary prevention practice [15]. The coronary risk analyser being developed by DEBEL will help the medical fraternity in overcoming this weakness and will serve as an important tool to decrease morbidity and mortality from CHD.…”