Treatment of Dyslipidemia SDPI CGP Healthy Heart Project March 8, 2006

LDL Goals Risk Category LDL-C Goal Initiate Lifestyle Change Consider Drug Treatment High Risk (  20%) CHD or CHD equiv < 100mg/dl  100mg/dl Moderately High Risk  2 risk factors (10-20%) < 130mg/dl  130mg/dl Moderate Risk  2 risk factors (10%) < 130mg/dl  130mg/dl  160mg/dl Low Risk 0-1 risk factors < 160mg/dl  160mg/dl  190mg/dl

Types of Medications Drugs that Affect Hepatic Lipoprotein Metabolism Drugs that Affect Hepatic Lipoprotein Metabolism 1) HMG-CoA Reductase Inhibitors (statins) - Lovastatin, pravastatin, simvastatin, fluvastatin (statins) - Lovastatin, pravastatin, simvastatin, fluvastatin 2) Nicotinic Acid - Immediate release (IR), sustained release (SR), extended release (ER) (IR), sustained release (SR), extended release (ER) 3) Fibrates - Gemfibrozil, fenofibrate, clofibrate

Types of Medications Drugs that Affect Intestinal Metabolism of Cholesterol Drugs that Affect Intestinal Metabolism of Cholesterol 1) Bile Acid Sequestrants - Cholestyramine, colestipon, colesevelam colestipon, colesevelam 2) Inhibitors of cholesterol absorption (vegetable derived) - Sterol/stanol esters (available in dietary (vegetable derived) - Sterol/stanol esters (available in dietary margarine – BeneChol®) margarine – BeneChol®) 3) Selective Cholesterol Absorption Inhibitor (CAI) - Ezetimibe, in combination Inhibitor (CAI) - Ezetimibe, in combination with HMG-CoA Reductase Inhibitors with HMG-CoA Reductase Inhibitors

Lifestyle Treatment of Dyslipidemia Lifestyle Changes Still Recommended for all patients Lifestyle Changes Still Recommended for all patients Physical Activity Physical Activity Smoking cessation Smoking cessation Weight Loss Weight Loss Dietary modification Dietary modification Reduce saturated and “trans” fats Reduce saturated and “trans” fats Increase fiber (25g/day) Increase fiber (25g/day) Consider plant sterols/stanols (2-3 servings/day) Consider plant sterols/stanols (2-3 servings/day)