In this review the indications for the available treatments for
dyslipidemias in the prevention of
coronary heart disease (CHD) are considered, and their efficacy according to the latest studies is analyzed. As data sources the authors used the main multicenter studies performed in the last twenty years to evaluate primary and
secondary prevention of CHD by correcting
dyslipidemias as well as the results of meta-analyses of these studies. All treatments considered were found effective in preventing CHD morbidity and mortality to some extent. In particular, the combination of diet with
niacin or hydroxymethylglutaryl
coenzyme A (
HMG CoA) reductase inhibitors seems to give the best results. These drugs induce a marked reduction of total and
low-density lipoprotein (
LDL) cholesterol and an increase of
high-density lipoprotein (
HDL) cholesterol concentrations. The use of diet,
niacin, and
HMG CoA reductase inhibitors reduces total as well as specific mortality. Treatment of
dyslipidemia to prevent CHD depends on the pattern and severity of
dyslipidemia, the presence of overt CHD, and the patient's response to diet. Pharmacologic treatment should be started only after
dietary modifications have been tried and must be combined with diet.
Drug side effects must also be considered, for they may affect patient compliance. High levels of total and
LDL and low levels of
HDL cholesterol are major risk factors for
coronary atherosclerosis. Correcting
lipid abnormalities can reduce the risk of development or progression of CHD. Diet and drugs are the main instruments available to normalize
lipid levels. The choice of
drug to combine with diet must be based on its specific effects on lipid metabolism, side effects, and efficacy in reducing CHD.