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A formal MEDLINE review was conducted (January 1994 to March 2007) using the following terms (limited to adult humans): cholesterol or low-density lipoprotein cholesterol AND guidelines orclinical trial. The Cochrane Controlled Trials Registry, references from the American College of Physicians, American Heart Association/American College of Cardiology lipid statements, and the National Cholesterol Education Program (NCEP) 2002 final report and 2004 update were also reviewed. The NCEP recommendations can be viewed at www.nhlbi.nih.gov/guidelines/cholesterol/index.htm.

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Dyslipidemia is a prerequisite risk factor in the development of the leading cause of mortality in the United States—atherosclerotic vascular disease (ASCVD). Dyslipidemia is prevalent in the United States; some estimates place the number of affected adults at one out of every two.1 Dyslipidemia is a modifiable ASCVD risk factor, unlike age, gender, or family predisposition, and its treatment reduces the rate of nonfatal myocardial infarction (MI), stroke, peripheral arterial disease, revascularization procedures, and all-cause mortality.2 However, many individuals with dyslipidemia go unrecognized and most patients with lipid abnormalities fail to achieve adequate metabolic control.3 To address these inadequacies, the National Heart, Lung, and Blood Institute of the National Institutes of Health convened an expert panel of researchers and clinicians to release a series of consensus guidelines on the detection, evaluation, and treatment of dyslipidemia. The latest NCEP recommendations were released in 2001.4 This Third Adult Treatment Panel (ATP-III) Report has been the focus of comment for guidelines issued from other specialty organizations.5,6 The ATP-III authors updated the report in 2004 to account for the implications of several large prospective clinical trials of lipid interventions.7 These clinical practice parameters emphasize the early identification of the individuals at risk and the targeted dietary, lifestyle, and pharmacologic treatment of dyslipidemia to prevent ASCVD events.

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Dyslipidemia is a term encompassing a variety of abnormal lipid profiles. Dyslipidemia includes elevated levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides, and low levels of high-density lipoprotein (HDL) cholesterol. In the past, these abnormalities were often referenced by their Fredrickson classification (Table 6-1). Dyslipidemia is now more fully described through sophisticated serum analyses to yield information on particle characteristics and their atherogenic potential. However, epidemiologic and clinical trial data continue to identify elevated LDL as the major lipid abnormality related to the development of ASCVD and recurrent adverse events.8 Poor diet, lack of exercise, tobacco use, prescription medications, and underlying medical disorders can all contribute to alterations in lipid metabolism. It is important to exclude such secondary causes of dyslipidemia prior to initiating treatment for a presumed primary lipid abnormality (Table 6-2).

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Table 6-1. Fredrickson Classification of Lipid Disorders

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