Atherogenic dyslipidemia: Lipoprotein abnormalities and implications for therapy

Atherogenic dyslipidemia is a lipoprotein profile combining 4 specific abnormalities: borderline-high total cholesterol levels; high triglyceride concentrations; small, dense, low-density lipoprotein (LDL) particles; and low high-density lipoprotein (HDL) concentrations. It is a predisposing factor to premature coronary artery disease (CAD), although separating and calculating the contribution of each abnormality to the risk of CAD is difficult, especially since the abnormalities often appear in this combination. The ratio of total cholesterol to HDL cholesterol is currently the most powerful single predictor of risk in dyslipidemic patients. Therapy for atherogenic dyslipidemia includes dietary changes aimed at decreasing intake of cholesterol-raising fatty acids and achieving weight reduction; exercise, which confers many of the benefits of weight reduction; and, when those measures fall to correct the lipid and lipoprotein profile, drug therapy. Nicotinic acid reduces triglyceride and cholesterol levels while raising HDL concentrations, but up to half of patients cannot tolerate its adverse effects. Fibric acids effectively lower triglyceride levels and are generally well tolerated but have little beneficial effect on the cholesterol profile. Statins offer marked reductions in total, LDL, and very low-density lipoprotein cholesterol levels and cause modest increases in HDL concentration. Combination therapy can enhance the efficacy of the individual drugs.