Hyperlipidemia is just a fancy word for 'high cholesterol' and as you may know, having high cholesterol can lead to a heart attack. Using the term 'hyperlipidemia' rather than 'high cholesterol' is often much more accurate. This is because there is much more to the blood lipid picture than just total cholesterol. When people get blood work done at the doctor's office they often get a blood lipid panel done. In addition to our cholesterol, this panel may show our LDL cholesterol, HDL cholesterol and triglycerides. Each of these lipids come together to make up our lipid panel and tells different things about the state of our health.

The National Cholesterol Education Program (NCEP) is an organization that has put out guidelines for the treatment of hyperlipidemia. These guidelines, revised in 2001, are where doctors who practice evidence-based medicine look to for guidance when treating patients with hyperlipidemia. It is important that you too be familiar with them so that you can work with your doctor to get the most out of your hyperlipidemia treatment.

Your Lipid Profile

 So now we know that our lipid panel is made up of many types of lipids but what do they all mean? Total cholesterol is the combination of all types of cholesterol in the blood, including LDL and HDL cholesterols. Triglycerides are another type of lipid found in the blood. High triglyceride levels put you at risk for heart disease. High triglyceride levels are often found in patients with diabetes. HDL cholesterol is often referred to as 'good' cholesterol. Higher HDL is associated with better heart health. LDL cholesterol is often called 'bad' cholesterol. Research shows that high LDL levels are the primary cause of coronary heart disease. LDL is a type of cholesterol that sticks to artery walls. When LDL sticks to artery walls, arteries can become blocked. When arteries, that normally supply oxygen and nutrient-rich blood to the heart become blocked, the heart becomes starved and a heart attack can occur.

Since LDL has been shown to be the primary cause of heart disease, we usually treat it first. It is ideal to for most people to have an LDL of less than 100. Although, your actual therapeutic goal will depend on how many risk factors for heart disease you have. The guidelines also define goals for HDL, total cholesterol and triglycerides.

Are You At Risk?

As mentioned before, your LDL is the lipid that is considered first when it comes to heart disease. It is this lipid that is looked at first when seeing if you need to be treated and it is this lipid that the doctor will monitor first to see how well your therapy is working. When deciding whether or not to treat you to prevent heart disease, your doctor will not only look at your lipid panel, particularly LDL, but will also look at what risk factors you have.

On a positive note, if you have an HDL, 'good cholesterol', greater than 60, you can remove one risk factor. You can work on increasing your HDL by maintaining a healthy weight, exercising, not smoking and consuming alcohol in moderation.

When determining your level of risk, your doctor will also look to see if you have any heart disease equivalents. These are conditions which automatically place you at a greater than 20% risk for developing heart disease in the next 10 years.

By looking at your risk factors and your cardiac disease equivalents, your doctor can get a pretty good idea of your risk for developing heart disease in the next 10 years.

Based on which risk category you fall into, you will have a different treatment goal for your LDL.

Therapeutic Lifestyle Changes (TLC)

Eating poorly, obesity and physical inactivity contribute to poor lipid profiles and heart disease risk. Therapeutic Lifestyle Changes (TLC) should be recommended to anyone who is not at their LDL goal, whether or not they are yet on medications. If lifestyle changes  alone fail to bring the LDL to the goal range in 6 weeks, medications may be needed. After medications are initiated, TLC should be continued. Patients who are starting with and LDL that is significantly high may need to be started on TLC AND medications to begin with. '

TLC includes eating right, maintaining a healthy weight and increasing physical activity. You be surprised how much following TLC can impact your lipid panel numbers, not to mention how much better you'll feel.

A sound diet should be high in fruits, veggies, whole grains and lean protein. It should be low in saturated fat (<7% of calories) and low in cholesterol (<200mg/day). Total fat should not exceed 25 to 30% of your total daily calories. Using butter-like products that contain plant sterols like 'Benecol' and 'Take Control' are recommended. Getting at least 30 minutes of physical activity on most days of the week is also recommended. These would include activities such as brisk walking, running, cycling or swimming (always check with your doctor before beginning any new exercise regimen).

Drug Therapy

There are many drugs available to help improve your lipid profile. Which drug you doctor chooses will depend on your lipid profile and other medication and conditions you have.

'Statins'

The technical term for these drugs is 'HMG CoA reductase inhibitors', but that is a mouthful so most people just call them 'statins'. They got this nickname because their names commonly end in the suffix 'statin'. Examples of statins include:

• Mevacor (Lovastatin)
• Pravachol (Pravastatin)
• Lescol (Fluvastatin)
• Lipitor (Atrovastatin)
• Baycol (cerivastatin)

These medications can lower LDL 18 to 55% and triglycerides by 7 to 30%. They can also increase your HDL by 5 to 15%. Side effects for these medications include headache, nausea, stomach upset, weakness and liver problems. A rare but serious side effect of statins in called rhabdomyolysis. This is a condition where damage occurs to the muscles. It usually starts as a pain in the muscle and can actually progress to a loss of muscle tissue. It can also lead to kidney failure and death. For this reason, unexplained joint or muscle pain should be brought to the attention of your doctor right away if you are taking a statin.

Bile Acid Sequestrants

These medications bind bile in the intestines forcing the liver to use cholesterol to make more bile. This has the effect of lowering cholesterol in the body. Examples of these medications include:

• Cholestyramine
• Colestipol
• Colesevelam

These drugs can lower your LDL by 15-30%. They can also increase your HDL by 3-5%. It generlaly does not change triglycerides so these drugs are generally not the best choice if you suffer form high triglycerides. Side effects include upset stomach and constipation. They can also decrease the absorption of other drugs.

 Nicotinic Acid

A part of the B vitamin complex, nicotinic acid is essential for various chemical reactions in the body. Usually marketed as niacin, it can lower your LDL by 5-25% and your triglycerides by 20-50%. It can also raise your HDL by 15-35%. Common side effects are flushing (turning red), high blood sugar, gout, liver problems and stomach upset.

Fibric Acids

It is not really known for sure how these medications work, although they are thought to help breakdown cholesterol in the body. Examples of these medications include:

• Lopid (Gemfibrozil)
• TriCor (Fenofibrate)

These drugs can lower your LDL by 5-20% and your triglycerides by 20-50%. It can also increase your HDL by 10-20%. Side effects include upset stomach, gallstones and muscle pain.

Treatment in general

Statins are the most widely recommended class of drugs for lipid control, especially when LDL is high. These have been shown to decrease the risk of heart disease and stroke by lowering cholesterol levels. Many times patients will come to the doctor's office with high LDL and high triglycerides, or high LDL and low HDL. Whatever the case, the LDL is usually treated first since it has been most strongly linked to heart disease. After the LDL is successfully treated, any other lipid abnormalities may be treated.

Successful treatment of your hyperlipidemia will involve the efforts of you and your health care team. It will require dedication on your part and may require that you change some of your habits. When you get discouraged, just remember the payoff of having a good cholesterol panel is well worth it. You will be less likely to develop heart disease, will feel better and be able to spend more time doing the things you love to do. If that isn't incentive to whip your lipid panel into shape, I don't know what is!

Author: Christi Larson, Pharm. D.