Since the 1980s, there has been significant success in the diagnosis
and treatment of dyslipidemia in the United States.
Physicians are treating a growing percentage of their patients
for the disease, most consumers have some awareness of the
importance of high cholesterol, and even pediatric treatment recommendations
are being debated. Yet with all the apparent focus
on treating cholesterol, there remains a formidable gap in the
treatment of mixed dyslipidemia and the achievement of lipids
goals by both primary care physicians and specialists such as cardiologists
and endocrinologists.
Consider the numbers. An estimated 101 million
Americans have dyslipidemia and about 35.3 million of
them are being treated with lipid therapies. Unfortunately,
significantly less than one-third of these treated patients are
achieving their risk stratified lipid goals.1
The primary goal of lipid therapy is to reduce low-density
lipoprotein (LDL-C) cholesterol to levels recommended
by the National Cholesterol Education Program (NCEP)
Adult Treatment Panel III (ATP III) guidelines. Studies have
shown elevated LDL-C is a major contributor to coronary
heart disease (CHD) and lowering it reduces a patient’s risk
of developing coronary artery disease. Similarly, studies
have demonstrated that hydroxyl-methyl-glutaryl-coenzyme
A (HMG-CoA) reductase inhibitors (statins) significantly
reduce LDL-C levels and associated CHD related
morbidity and mortality.2
While statins are the mainstay for reducing LDL-C, many
patients cannot meet NCEP goals on statin monotherapy. In
addition, an estimated 80% of patients treated with lipid
therapy for LDL-C have additional high-density lipoprotein
cholesterol (HDL-C) and/or triglycerides (TG) abnormalities.
3 After reducing LDL-C with statins, residual cardiovascular
(CV) risk remains for patients with elevated TGs and/or
low HDL-C. For this reason, NCEP and other national treatment
guidelines recommend going beyond LDL-C goals to
reduce this residual CV risk even further by treating patients
with abnormal TG and HDL-C levels.