Nonpharmacologic Treatment of Dyslipidemia

Mark C. Houston‚Åé, Sergio Fazio, Floyd H. Chilton, Dan E. Wise, Kathryn B. Jones, Thomas A. Barringer, Dean A. Bramlet

Vanderbilt University School of Medicine, Nashville, TN
Wake Forest University Health Sciences, Winston-Salem, NC
Presbyterian Center for Preventive Cardiology, Charlotte, NC
University of North Carolina School of Medicine, Chapel Hill, NC
Duke University School of Medicine, Durham, NC

Cardiovascular disease is the number one cause of morbidity and mortality in the United States,1 with coronary heart disease (CHD) and myocardial infarction (MI) being the leading causes of death.1 The 5 major risk factors for CHD hypertension, dyslipidemia, diabetes mellitus, smoking, and obesity1,2 account for 80% of the risk for CHD. Interventions, both pharmacologic and nonpharmacologic, can improve all of these risk factors and decrease the incidence of cardiovascular disease (CVD) and its consequences such as MI, angina, congestive heart failure, and stroke.3-6 In this article, we will review the nonpharmacologic treatment of dyslipidemia. Recent guidelines by the National Cholesterol Education Program recommend more aggressive control of serum lipids to reduce the incidence of CHD.7 Nutritional and dietary therapy, weight loss, exercise, and scientifically proven nutritional supplementation should be used initially in appropriately selected patients to manage dyslipidemia. Hypertriglyceridemia, frequently due to obesity, insulin resistance, metabolic syndrome, and diabetes mellitus,7 deserves special attention. Pharmacologic therapy should be administered in those cases that are at high or very high risk for CHD or who do not respond to nondrug therapy. Many patients prefer non-drug therapies for many reasons including adverse effects of anti-lipid drugs, contraindications or allergic reactions to drugs, perceptions of adverse effects of drugs, or personal preference for natural or alternative therapies. A more aggressive integrative approach to the management of dyslipidemia is recommended to improve CHD outcomes, minimize adverse effects, and reduce health care costs. Pharmacologic therapies for dyslipidemia have been discussed in detail in many recent reviews and will not be discussed in this article.