Dyslipidemia: Current Therapies and Guidelines for Treatment

esters, soy isoflavones, and nuts have all been shown to reduce LDL-C, in most cases by 5–10 mg/dL. 8 Physical activity does not reduce LDL-C independent of weight loss, but has been shown to improve cardiovascular health through other mechanisms, and is a cornerstone of weight loss. Overall, through weight loss, reducing dietary cholesterol and fat intake, LDL-C can be lowered by approximately 10–15 %. 9 Statins are the cornerstone of treatment for elevated LDL-C levels and are the most commonly prescribed pharmacological agent used to lower LDL-C. Statin medications inhibit hydroxymethylglutaryl CoA reductase, the rate-limiting enzyme in the production of cholesterol, leading to a reduction in intrahepatic cholesterol, up-regulation of hepatic LDL receptors, and enhanced hepatic LDL uptake, thereby lowering serum LDL. Many studies have evaluated the efficacy of statins in the primary and secondary prevention of cardiovascular disease ( Table 1 ). 10–21 One meta-analysis of statin trials for primary prevention in low-risk patients Abstract Despite significant advances in prevention and treatment, cardiovascular disease continues to be the leading cause of morbidity and mortality in the United States and worldwide. Nevertheless, the mortality from cardiovascular disease has decreased dramatically over the past few decades. Among the modifiable risk factors, dyslipidemia is a leading contributor to the development of coronary heart disease, and cholesterol-lowering treatment, primarily with statins, has been considered responsible for improvements in cardiovascular outcomes over the past 20 years. As such, physicians and researchers are frequently reevaluating the optimal approach and recommendations for cholesterol-lowering therapy for the primary prevention of cardiovascular disease. The objectives of this article are to review the evidence and efficacy of cholesterol-lowering therapies and to examine the current major societal guidelines for the management of dyslipidemia and appropriate patient selection.