Issues in managing hyperlipidaemia.

BACKGROUND: The relationship of plasma cholesterol to human coronary artery disease was established with the Framingham study in 1960 and an elevated plasma cholesterol is now considered the major modifiable risk factor for developing coronary artery disease. Recent studies, including the Australian LIPID study, have changed what we consider to be acceptable cholesterol levels. OBJECTIVE: To discuss the role of serum cholesterol levels, dietary modification and lipid lowering drug treatments in overall cardiovascular risk management. DISCUSSION: The current challenges in lipid management are to find ways to increase adherence to medication and deciding how far cholesterol should be lowered. Treatment of a particular patient depends not just on their serum cholesterol but on their overall cardiovascular risk. Diet has cardioprotective effects separate from modification of serum cholesterol levels and this may be true of some lipid lowering treatments.