The Singapore Family Physician

Back to issue Vol 37 No. 4 - Cardiometabolic Risk Update

Treating Dyslipidemia in the High-risk Group Patients- Current Management and Future Approach

Yong Quek Wei
The Singapore Family Physician Vol 37 No 4 - Cardiometabolic Risk Update
18 - 24
1 October 2011
Dyslipidemia is an important etiologic component to cerebrovascular, peripheral vascular and coronary heart disease worldwide, including Singapore. Most studies have shown that the 10% of the population with the highest LDL levels account for only 20-30%% of the CHD events. Conversely 70-80%% of CHD events occur in patients with so-called “normal” or “near-normal” levels. Standard guidelines therapy 5-6 years ago focus treatment only on those with very high cholesterol levels and ignore this large group of the people with “normal “or mildly raised cholesterol levels. New approaches in last few years include more intensive lowering of LDL-cholesterol levels, reducing triglycerides/non-HDL components and raising the high-density lipoprotein (HDL)-cholesterol level. In 2006, a target of <70 mg/dL LDL goal has became a “reasonable goal” in the guidelines for secondary prevention. High triglycerides or too-low HDL-cholesterol, also contribute to CHD risk and these lipid abnormalities often cluster with other risk factors, including obesity, insulin resistance, hyperglycemia, and hypertension (metabolic syndrome). Such patients are considered to have mixed, or atherogenic dyslipidemia, and include those with metabolic syndrome and type 2 diabetes. In patients whose triglyceride levels remain high (>200 mg/dL) or HDL-cholesterol levels low (<40 mg/dL) even after they have achieved their LDL-cholesterol goals, the NCEP ATP III guidelines recommend non−HDL-cholesterol as a secondary target of therapy. Combination therapies using fibrates seemed appealing and two ongoing trials are comparing combination therapy (statin with either niacin or a fibrate) with statin therapy to assess the incremental benefit of combination therapy.