Vnitr Lek 2000, 46(9):555-558

[Therapeutic goals in hyperlipoproteinemia].

R Ceska: III. interní klinika 1. LF UK a VFN, Praha.

In the treatment of hyperlipoproteinaemias (HLP) our main effort should be treatment of the patient and not achievement of defined biochemical values. The basic goals of HLP treatment can be defined on the basis of results of intervention studies as follows: reduction of general mortality, reduction of morbidity from IHD, reduction of the incidence of CMP, improved course of ischaemia of the lower extremities, better quality of life of patients with cardiovascular disease and reduced necessity of revascularization surgery. Even if we shall assume that the positive effect of treatment with HLP are in the first place optimization of the lipid spectrum, in particular a drop of total and LDL cholesterol, we cannot overlook so-called "non-lipid" effects of hypolipidaemic agents, in particular statins. In the treatment of patients with HLP it is important in the first place to evaluate the comprehensive risk of the patient, nevertheless it is possible to define "target values" e.g. according to recommendations of "European societies". Even these target values may be the subject of further discussions. It may be however stated that the objective is that total cholesterol should be less than 5 mmol/l, LDL cholesterol less than 3 mmol/l and triglycerides less than 2 mmol/l, HDL cholesterol higher than 1 mmol/l. Attention should be however drawn to the fact that evidence is increasing that in particular patients with already manifest IHD will benefit from even more aggressive treatment and attempts to achieve minimal lipid and lipoprotein values. LDL cholesterol should be reduced to 2.5 mmol/l and triglycerides should be below 2 mmol/l. It is a problem how to achieve these values. The strongest evidence is in favour of statin administration. On the other hand it is important to mention that optimation of the lipid and lipoprotein spectrum may be more important than prescription of a drug from a certain group.