Hyperlipidemia. What is 'normal,' who should be treated and how.

Considering that over half of Americans will die from cardiovascular disease, the over-whelming majority of those deaths being from atherosclerosis, we need to accept and act on the vast body of information derived from investigation of coronary risk factors. Identification of persons at risk needs to be done early--when the patient is in his or her 20s or 30s--not after an infarction has occurred or an angiogram indicates a problem. Although high serum lipid levels are obviously not the only factor involved in development of atherosclerosis, their early identification is a simple, cost-effective way to start preventive care. The concept of "normal" levels of cholesterol and triglyceride must be revised, and that of "safe" levels should be adopted instead. Patients with abnormal electrophoretic patterns should not be the only target; they are only the tip of the iceberg. A typical workup in a young patient consists merely of measurement of cholesterol and triglyceride levels. Further evaluation is necessary if the levels are high or the family history suggests a problem. Lipoprotein electrophoresis and computation of the ratio of high-density lipoprotein to low-density lipoprotein are then used not just as predictors but as a guide to therapy. Basic therapy begins with a change in life-style to incorporate dietary reduction of saturated fats and cholesterol and substitution of polyunsaturated fats. Other measures such as cessation of cigarette smoking, introduction of an appropriate exercise program and, most importantly, reduction of body weight complete the game plan.(ABSTRACT TRUNCATED AT 250 WORDS)