Dyslipidemia: Individualizing Care of Patients

Coronary heart disease (CHD), the leading cause of death in men and women in the United States, was responsible for about 1 of every 6 deaths in 2006.¹ The US National Health and Nutrition Examination Survey (NHANES; 2003 - 2006) estimated that 17.6 million Americans aged 20 years or older have CHD.¹

Atherosclerosis is a lifelong disease that results from a combination of genetic and environmental factors,² including oxidation, modification, and retention of apolipoprotein B (apoB)- containing lipoproteins in the arterial wall intima. The complex interaction between these modified lipoproteins and recruited inflammatory cells (eg, monocytes, T lymphocytes) in the intima leads to the formation of fatty streaks and, subsequently, fibrous plaques. Atherosclerotic plaques may progressively narrow the arterial lumen, restricting blood flow and causing clinical symptoms such as angina. Some plaques may rupture, causing sudden thrombosis of major conduit arteries and leading to myocardial infarction or stroke.

Atherosclerosis typically is asymptomatic for many years, and clinical symptoms of CHD do not arise until the disease has progressed substantially. As part of the 5-year longitudinal US population-based Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), a cross-sectional analysis of 2006 survey data revealed that CHD was first diagnosed after symptoms developed in 50% of patients; only 19% reported that a CHD diagnosis was made during routine screening.³ The study highlighted the need for earlier identification of risk and intervention, which can be achieved by raising public awareness and by screening for major CHD risk factors, such as dyslipidemia, hypertension, diabetes, smoking, obesity, physical inactivity, atherogenic dietary habits, increasing age, and family history of premature CHD.⁴ Among these risk factors, dyslipidemia has an important role in the initiation and progression of atherosclerosis for middle-aged and older persons and for young adults.⁵ A recent prospective study found that nonoptimal lipid levels in otherwise healthy young adults contributed to a higher prevalence of coronary calcification 2 decades later.⁶ Treatment of dyslipidemia must be accompanied by interventions to address the modifiable risk factors for CHD, including lifestyle changes, such as smoking cessation, diet and weight control, and increased physical activity, as well as treatment of hypertension and diabetes.

Internal server error