Management of dyslipidaemia.

Correspondence to: Professor Gilbert R Thompson, Metabolic Medicine, Imperial College, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK; [email protected] _________________________ D yslipidaemia is a preferable term to hyperlipidaemia because it includes risk factors such as a decreased concentration of high density lipoprotein (HDL) cholesterol as well as qualitative changes in low density lipoprotein (LDL), notably the presence of small, dense LDL particles. Both abnormalities, together with raised triglycerides, are features of the metabolic syndrome, increasingly recognised as a harbinger of coronary heart disease (CHD). The simplest classification of dyslipidaemia defines the lipid phenotype as hypercholesterolaemia, hypertriglyceridaemia, or mixed hyperlipidaemia (MHL). Each can result from dysfunctional mutations of dominantly expressed genes encoding receptors, enzymes or transfer proteins involved in lipoprotein metabolism, usually indicated by a familial pattern of inheritance. More often, however, dyslipidaemia reflects the interaction between weaker genetic influences and environmental factors such as diet and a sedentary existence. In these situations the adoption of changes in lifestyle is the first line of treatment whereas monogenically determined dyslipidaemias, such as familial hypercholesterolaemia (FH), usually require lipid regulating drug treatment.