LDL-C
  • The majority of patients will achieve target LDL-C levels on statin monotherapy
  • A minority of patients may require combination therapy with:
    • Ezetimibe (inhibits cholesterol absorption)
    • Cholestyramine, colestipol or colesevelam (inhibit bile acid reabsorption)
    • Niacin
HDL-C
  • Low HDL-C may pose no risk, depending on genetic type
  • Impact of medications on HDL-C:
    • Statins have little effect
    • Fibrates can modestly raise HDL-C (5% to 10%)
    • Niacin can increase HDL-C 15% to 25%
    • Medications may not increase HDL-C to a clinically significant extent
  • Smoking cessation, weight loss, exercise and moderate alcohol intake all increase HDL-C
Triglycerides
  • Lower triglyceride levels are associated with decreased CVD risk
  • For hypertriglyceridemia, health behaviour interventions are first-line:
    • Dietary therapy
    • Exercise
    • Weight loss (focus on restriction of refined carbohydrates)
    • Reduced alcohol intake
    • Increased intake of omega-3 fatty acids
  • Fibrates may prevent pancreatitis in patients with extreme hypertriglyceridemia (>10 mmol/L)
Combination Therapy
  • Statin with niacin
    • Effective in patients with combined dyslipidemia and low HDL-C
  • Statin with a fibrate
    • May be used with close patient follow-up
  • Statin with omega-3 fatty acids
    • May lower triglycerides and help achieve TC:HDL-C ratio target in patients with moderate hypertriglyceridemia

HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol. CVD: cardiovascular disease; TC: total cholesterol.