Reviews

The recommendations for treatment of elevated LDL cholesterol generally follow the guidelines of both the NCEP and a recent ADA consensus development conference, with the following caveats. Pharmacological therapy should be initiated after behavioral interventions are used. However, in patients with clinical CHD or very high LDL cholesterol levels (>200 mg/dl), pharmacological therapy should be initiated at the same time behavioral therapy is commenced. The order of priorities for the treatment of dyslipidemia states that the first goal is to lower LDL cholesterol, followed by HDL elevation and triglyceride lowering. Triglyceride lowering have been advised by all authorities, though there is till date no clear cut recommendation from authorities for a prescribed strict goal to be achieved by pharmacological means. It is believed that a serum triglyceride concentration of 200 mg/dl is somewhat elevated, and a concentration of more than 400 mg/dl is considered high according to NCEP guidelines. The initial therapy for hypertriglyceridemia is by improving glycemia, behavioral modification with weight loss, increased physical activity to be advocated aggressively before the introduction of fibrates.

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