| Monitor ( see also : Organization of Clinical Monitoring
) : |
 |
 |
dietary quality and quantity ( including alcohol ) |
|
|
physical exercise level |
|
|
body weight |
|
|
blood glucose control |
|
|
lipid profile including triglycerides and LDL cholesterol |
Begin : |
|
 |
Optimize blood glucose control as far as is possible |
|
|
Establish lipid profile before beginning a trial of therapy |
| Use : |
|
|
a statin |
if |
LDL cholesterol >=3.0 mmol/l ( >=115 mg/dl ) |
|
|
|
( >4.0 mmol/l ( >155 mg/dl ) if low risk including thin elderly ) |
|
|
a fibrate |
if |
triglyceride >2.2 mmol/l ( >200 mg/dl ) |
|
|
|
and |
LDL cholesterol <3.0 mmol/l ( <115 mg/dl ) |
|
|
a fibrate first if triglyceride markedly elevated ( >6.8 mmol/l ( >600 mg/dl ) ); check thyroid, renal, and liver function ( and apoE genotype if available ); consider combination therapy with a statin if LDL cholesterol remains elevated |
|
|
combination therapy beginning with statin for high LDL cholesterol and triglyceride |
Choise of agents |
|
Statin : choice will usually be determined by relative cost-effectiveness locally |
|
Fibrates : ciprofibrate and
fenofibrate are probably more effective than bezafibrate in
lowering triglycerides |
|
Other drugs : in general not
recommended, unless severe hyperlipidaemia and intolerance to
statins and/or fibrates |
