Hyperlipidemia. When does treatment make a difference?

A high serum cholesterol level is regarded as a major contributor to the development of coronary atherosclerosis. Screening for hyperlipidemia should begin no later than age 35 for men and age 45 for women. Individuals with additional risk factors for coronary artery disease should be screened earlier. When values are not within a desirable range, further assessment should be done by determining high-density lipoprotein and triglyceride levels. The initial approach to treatment of hyperlipidemia includes diet, exercise, and weight loss. Smoking should be proscribed. When nonpharmacologic intervention fails, "statins" are increasingly being selected as agents of first choice. Recommendations for the busy practitioner include consistently identifying the hyperlipidemic patient, setting target goals for lipid values, addressing modifiable risk factors, and providing appropriate pharmacologic intervention (eg, aspirin, antioxidants, and beta blockers in patients with established disease; angiotensin-converting enzyme inhibitors in patients with systolic dysfunction; estrogen replacement in selected patients) and treatment to attain target goals in lowering cholesterol.