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From Citizendium, the Citizens' Compendium

Hypercolesterolemia is "a condition with abnormally high levels of cholesterol in the blood. It is defined as a cholesterol value exceeding the 95th percentile for the population."^[1]

Contents 1 Treatment 1.1 Primary prevention 1.2 Secondary prevention 1.3 Diabetic patients 2 References

Treatment

Clinical practice guidelines by the National Institute for Health and Clinical Excellence recommend treatment if the estimated 10 year risk of cardiovascular disease is at least 20%.^[2][3]

Ezetimibe is one drug that can reduce cholesterol. However, a recent randomized controlled trial found it did not reduce atherosclerosis in the carotid artery.^[4]

Primary prevention

Overall mortality is insignificantly reduced from 6.6% over 4.3 years to 6.1% in patients without prior cardiovascular disease (Number needed to treat, although statistically insignificant, is estimated to be 200).^[5]

Secondary prevention

Clinical practice guidelines by the National Institute for Health and Clinical Excellence recommend treatment goal of <4 mmol/l (77 mg/dl)or a low density lipoprotein cholesterol concentration of <2 mmol/l (154 mg/dl).^[2][3]

Diabetic patients

For more information, see: Diabetes_mellitus_type_2#Hypercholesterolemia

Statin therapy prevents major vascular events in about 1 of every 24 patients with diabetes who use the treatment for 5 years if they are similar to the patients in the meta-analysis by Kearney et al (Number needed to treat is 24).^[6]

Treating to a goal of LDL-C < 70 mg/dl and systolic blood pressure to < 115 mm Hg may cause regression of carotid intial media thickness in a randomized controlled trial.^[7]

References

1. ↑ Anonymous. Hypercholesterolemia. National Library of Medicine. Retrieved on 2008-01-18.
2. ↑ ^2.0 2.1 Cooper A, O'Flynn N (2008). "Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance". BMJ. PMID 18511800.
3. ↑ ^3.0 3.1 Anonymous (2008). Lipid modification. National Institute for Health and Clinical Excellence. Retrieved on 2008-08-26.
4. ↑ Kastelein JJ, Akdim F, Stroes ES, et al (April 2008). "Simvastatin with or without ezetimibe in familial hypercholesterolemia". N. Engl. J. Med. 358 (14): 1431–43. DOI:10.1056/NEJMoa0800742. PMID 18376000.
5. ↑ Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK (2006). "Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials". Arch. Intern. Med. 166 (21): 2307–13. DOI:10.1001/archinte.166.21.2307. PMID 17130382.
6. ↑ Kearney PM, Blackwell L, Collins R, et al (2008). "Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis". Lancet 371 (9607): 117–25. DOI:10.1016/S0140-6736(08)60104-X. PMID 18191683.
7. ↑ Howard, B. V., Roman, M. J., Devereux, R. B., Fleg, J. L., Galloway, J. M., Henderson, J. A., et al. (2008). Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized Trial. JAMA, 299(14), 1678-1689. DOI:10.1001/jama.299.14.1678.