Managing elevated blood lipid concentrations. Who, when and how?

Patients with elevated serum cholesterol concentrations, particularly men, should be treated to lessen their chance of subsequent morbidity from coronary heart disease. Reduction of elevated triglyceride levels is more contentious, but is justified in severely affected individuals. The levels requiring treatment can only be judged by consideration of the overall clinical setting, including patient age and sex, the presence of other risk factors and the particular lipoprotein abnormality. In general, relative youth, male sex, a low level of high density lipoprotein (HDL) cholesterol and a strong family history of coronary heart disease will favour vigorous therapy. The possibility that hyperlipoproteinaemia is secondary to some other metabolic disorder should be considered, particularly in regard to elevated triglyceride levels.