Volume 1 Guidelines Management of Hyperlipidaemia

MANAGEMENT OF HYPERLIPIDAEMIA

ACTION LIMITS

Plasma triglyceride

2.3-4.6 mmol/l
200-400 mg/dl

LDL cholesterol

<3.5 mmol/l
<135 mg/dl

CONSERVATIVE MEASURES

This condition is usually corrected by vigorous, persistent, conservative care.
Emphasise correction of overweight, and of underlying causes, e.g. alcohol abuse, diabetes, use of thiazides.

DRUGS

Consider if condition is unresponsive to diet and exercise and if hypertriglyceridaemia is accompanied by low HDL cholesterol in a patient with coronary disease or at high global risk. (Formal proof of benefit not available).

Options are fibrates, nicotinic acid or fish oil.

RETESTING

3-monthly, increasing to 1-5 years according to level of risk.

ACTION LIMITS

Plasma triglyceride

>4.6 mmol/l
>400 mg/dl

LDL cholesterol

<3.5 mmol/l
<135 mg/dl

CONSERVATIVE MEASURES

Conservative measures may be very effective.
Extended trial not appropriate since triglyceride >6 mmol/l can increase rapidly and lead to acute pancreatitis.

DRUGS

Consider drugs if conservative measures have not achieved substantial improvement in 8-12 weeks.

Options are fibrates, nicotinic acid or fish oil.

RETESTING

Monthly, increasing to 6-monthly.

Hipertriglyceridaemia without elevation of LDL cholesterol should be treated conservatively wherever possible.

Hypertriglyceridaemia is often accompanied by low HDL cholesterol levels. This combination confers an increased risk of CHD.
Ensure that blood samples were taken while the patient was fasting (14 h).
Treat overweight and deal with underlying causes (notably overuse of alcohol, diabetes, and drugs such as thiazides and retinoids).
Prescribe lipid-lowering diet and advise regular suitable exercise.

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