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Feature Article

Lipid therapy: a 2007 update

Leon A Simons

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Abstract

Management of patients’ lipid levels is a key daily activity for all GPs. While statins are the most often used lipid lowering agents, each patient’s lipid profile should be examined as a nonstatin choice may be more appropriate.

Key Points

  • Lipid and lipoprotein levels are key risk factors in coronary heart disease (CHD) and ischaemic stroke.
  • Presciption of lipid therapy is likely to remain or even increase as a key daily activity for GPs.
  • The predominant lipid pattern in an individual patient is a factor in selecting the most appropriate lipid therapy choice.
  • LDL cholesterol reduction by statins reduces the future risk of cardiovascular disease in patients with and without a prior history of CHD.
  • There remains significant residual coronary risk in patients despite statin therapy.
  • Those patients not reaching target LDL cholesterol levels on statin therapy may be better managed by the addition of ezetimibe to the statin therapy, or a switch to the combined ezetimibe–simvastatin preparation.
  • Patients with low HDL cholesterol and high triglyceride levels may be better managed with fenofibrate or a combination of statin and fenofibrate.
  • As a general rule, combination lipid therapy is a second step treatment rather than an initiating therapy.

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