MANAGEMENT OF HYPERCHOLESTEROLAEMIA

Hypercholesterolaemia is treated primarily by correction of overweight, careful instruction in a lipid-lowering diet and removal of underlying causes.
Drug therapy should always be based upon LDL cholesterol values .

ACTION LIMITS

Plasma cholesterol 5.2-6.5 mmol/l 200-250 mg/dl

LDL cholesterol 3.5-4.5 mmol/l 135-175 mg/dl

• CONSERVATIVE MEASURES (Effective for the vast majority)
  
  • If the patient is not at high global risk, provide a single dietary counselling session.
  • If the patient is at high risk, regular follow-up and, if needed, further counselling is carried out.

• DRUGS
  
  • Required uncommonly, for patients with coronary disease or at high global risk who do not reach target levels after prolonged trial of conservative care.

• RETESTING
  
  • If global risk is mildly increased, retest younger patients at 5 years or older patients annually.

ACTION LIMITS

Plasma cholesterol 6.5-7.8 mmol/l 250-300 mg/dl

LDL cholesterol 4.5-5.5 mmol/l 175-215 mg/dl

• CONSERVATIVE MEASURES (Effective for most)
  
  • Dietary counselling, follow-up at 3 months, and recounselling if required, preferably by a dietician.

• DRUGS
  
  • Consider for patients with coronary disease or at high global risk, after a 3-6 month trial of conservative measures.
  • Use statins, resins or fibrates.

• RETESTING
  
  • 2- to 3-monthly, later 6- to 12-monthly.

ACTION LIMITS

Plasma cholesterol >7.8 mmol/l >300 mg/dl

LDL cholesterol >5.5 mmol/l >215 mg/dl

• CONSERVATIVE MEASURES (Sometimes effective)

• DRUGS
  
  • Commonly needed for major genetic hyperlipidaemias, e.g. familial hypercholesterolaemia, after a 3-month trial of other measures.
  • All patients in this group are at high risk.
  • Use statins or resins after a trial of (maximum) 6 months of other measures.

• RETESTING
  
  • 2-monthly, increasing to 6-monthly when controlled.

LDL CHOLESTEROL ACTION LIMITS The epidemiological relationship between plasma cholesterol and CHD has been studied more extensively than that between LDL cholesterol and CHD. Plasma and LDL cholesterol levels correlate but do not correspond exactly because of variation in cholesterol content in HDL and VLDL. Since LDL is the most atherogenic lipoprotein, major therapeutic decisions, especially on drug therapy, are based on LDL cholesterol rather than plasma cholesterol. The LDL cholesterol action limits and target values shown in the Tables correspond approximately to the plasma cholesterol levels indicated.