ROBERT I. LEVY, M.D.; DONALD S. FREDRICKSON, M.D.; RICHARD SHULMAN, M.D.; DAVID W. BILHEIMER, M.D.; JAN L. BRESLOW, M.D.; NEIL J. STONE, M.D.; SAMUEL E. LUX, M.D.; HOWARD R. SLOAN, M.D., Ph.D.; RONALD M. KRAUSS, M.D.; PETER N. HERBERT, M.D.
The first step in the management of primary hyperlipidemia is its translation into hyperlipoproteinemia, which can be done by measuring the plasma cholesterol and triglyceride concentrations and noting the appearance of the plasma left overnight at 4 °C. Diet is the keystone of effective therapy. In type I hyperlipoproteinemia diet (very low-fat) is the only therapy. Type lla is best treated by the combination of a low-cholesterol diet enriched with polyunsaturated fat and cholestyramine. In types III, IV, and V, calorie restriction with reduction to ideal body weight should be followed by a maintenance diet controlled in fat or carbohydrate, or both. Clofibrate is extremely effective in type III; it may sometimes be useful in types IV and V, but, when not contraindicated, nicotinic acid is usually more effective. Since all of the currrently available hypolipidemic drugs are associated with some side effects, and their use is often based on a still unproved presumption (that if lipids are lowered so is the risk of coronary artery disease), they should be used with circumspection.
LEVY RI, FREDRICKSON DS, SHULMAN R, BILHEIMER DW, BRESLOW JL, STONE NJ, et al. Dietary and Drug Treatment of Primary Hyperlipoproteinemia. Ann Intern Med. ;77:267–294. doi: 10.7326/0003-4819-77-2-267
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Published: Ann Intern Med. 1972;77(2):267-294.
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