Evaluation and Treatment of Hypercholesterolemia

Basic science research and clinical investigations spanning the last two decades have expanded our understanding lipoprotein physiology, pathophysiology, and the contribution of lipids to CHD. Evidence is at hand that reductions in cholesterol and LDL-C lead to beneficial changes in CHD risk and endpoints. While it has been argued that lowering cholesterol may not result in longer life span depending on baseline age, degree of cholesterol evaluation, and presence or absence of other risk factors, the bulk of evidence favors lowering cholesterol when it is excessively elevated in individuals, and moving toward a lower population distribution of cholesterol values. Hypercholesterolemia should be approached by altering other risk factors when appropriate, reduction of intake of total and saturated fat and cholesterol, and if dietary therapy is inadequate, drug therapy. The most effective drugs currently for hypercholesterolemia include cholestyramine, colestipol, niacin, and lovastatin. Each drug has inherent advantages and disadvantages and these should be considered in defining the optimal regimen for each patient.