Treatment of Hyperlipidemia

Niacin can increase HDL by 30% and decrease triglycerides by 30% and LDL by 20%. Major adverse reactions include flushing, gastrointestinal symptoms, elevation of liver function tests, uric acid, and serum glucose levels. The new longer-acting formulation has been associated with less flushing. Another class, the bile acid resins, including cholestyramine and colestipol, may play an adjunctive role in therapy. Their effect on the lipid panel is mild compared with those of the other class and they can increase triglyceride levels. Many patients find the gritty taste of the granular formulation unpalatable. The bile acid resins have a favorable safety profile. Most adverse events occur locally in the gut.

Conclusions

The emergence of statins as a safe and effective, although costly, therapy for hyperlipidemia and the development of clinical guidelines advocating their increased use will place family physicians under added pressure to screen for and treat hyperlipidemia. While the general value of lifestyle changes is recognized in national recommendations, more effective ways for physicians to implement them successfully in ambulatory settings are needed.

An optimal evidence-based approach to hyperlipidemia uses the new NCEP III guideline, which combines traditional risk factor assessment with assessment for CAD using the Framingham tables to determine LDL goals and appropriate treatment modalities. Statins are first-line agents for patients who are candidates for drug therapy. Discussions between clinicians and patients of the NNTs for primary and secondary prevention will help foster patient-centered discussions on the role of medical, economic, and quality-of-life issues in the decision-making process.