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 or clinical 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.
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.
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).
Table 6-1. Fredrickson
Classification of Lipid Disorders |Favorite Table|Download (.pdf)
Table 6-1. Fredrickson
Classification of Lipid Disorders
|Phenotype||Lipoprotein Elevation||Total Cholesterol||Triglycerides||Atherogenicity|
|IIb||LDL and VLDL||++||+||++|
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