Evidence based pharmacy practice (EBPP) : dyslipidaemia

Abstract

Dyslipidaemia is a disorder of lipoprotein metabolism that alters the concentration or composition of lipoproteins. Atherosclerosis and pancreatitis are the two major complications of dyslipidaemia. The most common dyslipidaemia is hypercholesterolaemia, which is one of the major risk factors for coronary heart disease (CHD) and cerebrovascular morbidity and mortality. Severe hypertriglyceridaemia can cause acute pancreatitis. Initial therapy for any lipoprotein disorder is lifestyle changes which include smoking cessation, a diet low in saturated fats, weight loss if indicated and regular aerobic exercise. Correction of any precipitating factors such as uncontrolled diabetes, alcohol abuse or medications should be undertaken. If lifestyle changes are not effective, then drug therapy should be considered. The choice of drug therapy is dependent on the type of lipoprotein disorder. The most effective cholesterol lowering drugs are the statins (HMG CoA reductase inhibitors). They work by inhibiting the rate-limiting step in cholesterol synthesis. They are the most potent form of monotherapy as well as being the most cost effective. Patients not responding to statin monotherapy can be treated with combination therapy, which may include bile acid resins, fibrates, nicotinic acid or ezetimibe. Dietary supplements such as plant sterols and fish oils can also assist in lowering cholesterol levels. Lipid lowering is beneficial in patients with dyslipidaemias for both primary and secondary prevention of CHD.