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How to Use This Handout

This handout is designed to help you use the lipid lowering drugs effectively. Although there are many different "correct" approaches to successful lipid disorder management, the path outlined here is designed to combine simplicity with cost-effectiveness.

Our underlying theme is that use of more than one lipid lowering drug will be necessary to achieve goal lipid levels in many patients, and therefore familiarity with all of the drugs is necessary for success. Helpful hints to improve tolerance to niacin and sequestrants are provided, in addition to information on the 'statins' and fibrates.

A word about lipid goals. Establishing lipid goals with each patient is an extremely important part of lipid disorder management. The National Cholesterol Education Program (NCEP) provides useful guidelines. For example, for a patient with coronary heart disease, drug therapy is recommended if the LDL cholesterol remains above 130 mg/dl despite diet, to achieve an ideal LDL goal of less than 100 mg/dl.

Unfortunately, this ideal may not be realistic in many patients, particularly those with moderate to severe LDL elevations. On the other hand, a more reasonable target may be an initial LDL goal of <130 mg/dl, with a secondary target of <100 mg/dl for patients successfully achieving the initial goal. You may wish to adopt similar initial goals for patients (without heart disease) with two or more risk factors (160 mg/dl) and less than two risk factors (190 mg/dl). The ideal goal suggested by the NCEP would be 30 mg/dl less than these "initial" goals. Remember: the NCEP guidelines are only guidelines and do not dictate, but merely suggest, appropriate strategies.

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