Effective management of dyslipidaemia among patients with cardiovascular risk: updated recommendations on identification and follow-up.
Hobbs R., Hoes A.
The identification of modifiable risk factors for coronary heart disease (CHD) and therapies for their management has led to the development of many national and international guidelines. However, despite the general acceptance and use of such guidelines, CHD, the principal manifestation of cardiovascular disease (CVD), remains the leading cause of mortality worldwide, with dyslipidaemia one of the most important modifiable risk factors. Many patients remain unidentified and untreated or, if receiving treatment, do not reach guideline targets. All guidelines recommend screening strategies for identifying at-risk patients and assessment. Lifestyle changes are the basis of any treatment strategy, with patients often requiring behavioural counselling. Those unable to achieve or maintain adequate risk reduction on lifestyle changes alone, and high-risk patients, also require pharmacotherapy. Reducing low-density lipoprotein cholesterol (LDL-C) remains an important goal of pharmacotherapy, although some patients, particularly those with diabetes, may need to reduce triglycerides and increase high-density lipoprotein cholesterol. Statins are the first-choice agents for LDL-C reduction. However, optimal dosage is important. Many patients fail to adhere to therapy, and primary care physicians are best placed to instigate adherence-enhancing strategies, which may ultimately reduce mortality and morbidity. This clinical review highlights the problems in current CHD risk management and summarises the updated evidence base within clinical recommendations to effectively manage at-risk patients.