Dyslipidaemia in Clinical Practice PDF

Preface

The management of dyslipidaemia has become an important topic for health professionals working not only in primary care, but also in hospital, where the impact of dyslipidaemia is experienced across a wide range of medical and surgical specialities. Although now routine, it is important to remember that only in the last decade has dealing with dyslipidaemia become an established part of clinical practice. The acquisition and application of new knowledge has been rapid and this second edition of Dyslipidaemia in Clinical Practice has been extensively rewritten to bring the reader up to date with both new information and current issues for patient care.

What has not changed is the worldwide burden of cardiovascular disease and the need to tackle dyslipidaemia. The problem is as relevant in the developed societies of Europe and North America as it is in the developing world, where unhealthy lifestyle habits are burgeoning. Across the emergent spectrum of atherosclerotic vascular disease (coronary heart disease, cerebrovascular disease and peripheral arterial disease) dyslipidaemia remains of central importance both in terms of causation and therapeutic modification to reduce disability and death from these sequelae.

Since publication of the first edition, the expanding evidence base has confirmed the benefit of modifying dyslipidaemia for a spectrum of individuals with a wider range of cardiovascular risk. For individuals at high cardiovascular risk, lowering low-density lipoprotein (LDL) cholesterol by 1mmol/L can be expected to reduce cardiovascular events by 20%, irrespective of age, sex or baseline values. For individuals at very high risk, more radical reduction of LDL cholesterol produces further benefits, and international guidelines advocate lower target levels to reflect this new evidence. The greatest benefits in cardiovascular event reduction seem to result from the greatest absolute LDL cholesterol reductions and new therapies have emerged capable of achieving the low levels required. The risk reductions seen in hypercholesterolaemic patients in clinical trials are remarkably consistent and have also been seen in patients with type 2 diabetes mellitus and hypertension. Even patients with lower degrees of cardiovascular risk benefit from lipid modification, albeit that the absolute benefits may be less. The threshold level of cardiovascular risk for lipid modification is defined not only by clinical effectiveness and acceptability, but also affordability, the latter especially since simvastatin became available as a generic drug in many countries.

In terms of effective health care delivery, most of the burden for lowering cardiovascular risk falls on individuals working in primary care. Primary care is well placed to tackle the enormity of the task and its holistic, multidisciplinary nature is well suited to multiple risk factor management and the establishment of the sort of therapeutic alliances that are so important for long-term treatment concordance. The introduction of performance related incentives for the management of chronic disease in the UK has resulted in spectacular improvements in the treatment of dyslipidaemia. For example, in patients with coronary heart disease, the target cholesterol of