Treatment of Hyperlipidemia

It is necessary to first identify and treat any potential underlying medical problems, such as diabetes or hypothyroidism, that may contribute to hyperlipidemia. Treatment of hyperlipidemia itself includes dietary changes, weight reduction and exercise. If lifestyle modifications cannot bring about optimal lipid levels, then medications may be necessary.

Current national guidelines suggest a LDL cholesterol goal of <100 mg/dl for individuals already with heart disease or diabetes, <130 mg/dl for those with moderate risk of heart disease, and <160 mg/dl for everyone else. Your doctor can calculate your “risk score” for heart disease. This score can then be used to determine whether you need to start taking medications to lower your LDL cholesterol.

Although there are no firm treatment targets for HDL cholesterol or triglycerides, most experts agree that optimal HDL cholesterol and triglyceride levels are >40 mg/dl and <200 mg/dl, respectively.

Medications most commonly used to treat high LDL cholesterol levels are statins, such as atorvastatin (Lipitor) or simvastatin (Mevacor). These medications work by reducing the production of cholesterol within the body. Although safe and effective, statins very rarely cause muscle damage, typically when used in combination with other medications. Thus, it is important to let your doctor know whether you develop any generalized body ache or start a new medication when you are taking statins.

Other medications used to treat high LDL cholesterol levels include ezetimibe (Zetia), which decreases the absorption of cholesterol from the gut; bile-acid sequestrants (Questran), which eliminate cholesterol from the body; and nicotinic acid (Niacin), which, in addition to lowering LDL cholesterol, raises HDL cholesterol.

Hypertriglyceridemia is typically treated with a class of medications called fibrates. Included in this class are gemfibrozil (Lopid) and fenofibrate (Tricor). Similar to statins, fibrates are safe and effective but may cause muscle damage, usually when used in combination with other medications.