Drug and alternative therapies for hyperlipidemia.

The recent guidelines for detection and treatment of hypercholesterolemia together with specific therapeutic goals have stimulated interest in, and use of, lipid lowering agents. The last decade has seen an explosive growth in the drug discovery area which is now translating into clinical trials with many new lipid lowering agents. In addition, clinical trials assessing clinical outcomes and cost effectiveness are resulting in a changing approach to how current lipid lowering drugs are used, especially in terms of dosing and combination therapies. At present only four classes of lipid altering agents remain in wide use; bile acid binding resins, niacin, fibrates and HMG CoA reductase inhibitors. Although only a decade has passed since the first HMG CoA reductase inhibitor, lovastatin, entered clinical trials this group of compounds are not only the most widely used lipid lowering agents, but more than six such agents have been or are currently being developed. In addition to pharmacological therapies, there have been significant advances in the non-pharmacological treatment of hypercholesterolemia, the most important being LDL-receptor gene replacement and selective LDL-apheresis.