Abstract and Introduction

Abstract

Decreasing very high triglyceride (TG) levels (≥500 mg/dL) is recommended to prevent pancreatitis. Decreasing low-density lipoprotein cholesterol (LDL-C) is the primary lipid treatment target to reduce the risk of atherosclerotic coronary heart disease. A secondary lipid treatment target for patients at LDL-C goal, but with persistent TG elevations, includes achievement of non-high density lipoprotein cholesterol goals (non-HDL-C). Statins are the mainstay of therapy to lower LDL-C, but statin monotherapy may not achieve all lipid treatment goals. Thus, in patients with multiple lipid abnormalities, combination lipid-altering therapy is often necessary. Drugs such as niacin and fibrates provide lipid benefits beyond LDL-C when used in combination with a statin. Prescription omega-3-fatty acids combined with statin therapy also provide improvements in lipid parameters beyond cholesterol alone.

Introduction

In 2004, more than 15 million Americans were diagnosed with atherosclerotic coronary heart disease (CHD).^[1] Death occurs in an estimated 38% of people experiencing a CHD-related event.^[1] Thus, CHD poses an enormous healthcare and economic burden. In the United States alone, the 2007 estimated direct and indirect costs of CHD were more than $150 billion.^[1] Modifiable risk factors for CHD include cigarette smoking, dyslipidemia, hypertension, diabetes mellitus, abdominal obesity, limited physical activity, limited daily fruit and vegetable consumption, excessive alcohol intake, and psychosocial factors.^[2]