Vnitr Lek 1996, 42(8):568-572

[Treatment of hyperlipoproteinemia in clinical practice].

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

There are sufficient arguments for treatment of hyperlipoproteinaemia at present and this treatment is considered not only rational but also an essential procedure in primary and in particular in secondary prevention of cardiovascular diseases. Views of scepticists as regards this treatment are, with regard to the most recent epidemiological studies with hypolipidaemic agents, not very convincing and the majority is refused. Treatment of patients with hyperlipoproteinaemia is comprehensive, its basis being dietary and lifestyle measures. The latter are, if they are not sufficiently effective, with increasing frequency supplemented with medicamentous intervention. This treatment is then as a rule very effective and leads to rapid achievement of desirable "target values" of parameters of lipid and lipoprotein metabolism. This comprehensive therapeutic algorithm is considered the modern approach to primary and secondary prevention of cardiovascular diseases. If a long-term favourable effect on the lipid spectrum is to be achieved in individual subjects and whole populations (and in particular in populations of subjects with the highest risk of manifestation of complications of atherosclerosis), it is essential to implement the mentioned therapeutic measures on a long-term basis, frequently for the rest of life. Considering contemporary prices of medicaments which are used to influence risk factors of atherosclerosis, this quite understandably worries health economists. Despite their "economic" objections it is important to give maximal support to preventive measures. Therapeutic procedures in advanced disease may be finally incomparably more expensive than soundly implemented preventive measures. On the other hand, it is a must to treat disorders of the lipid metabolism, as well as other risk factors of atherosclerosis such as hypertension or diabetes mellitus rationally, respecting recent results of basic and applied research. It is also a great advantage if we can use as a basis for the diagnostic and therapeutic algorithm international widely accepted recommendations of European and American societies. We also use their recommendations as guidelines when seeking the right patient or group of subjects on whom our greatest therapeutic effort should be focused.