Evaluation and treatment of lipid disorders in women

The latest report from the National Cholesterol Education Program has reaffirmed that the primary lipid goal for the prevention of atherosclerotic vascular disease (AVD) is to achieve a normal low-density lipoprotein (LDL) cholesterol (<130 mg/dL) by diet in normal individuals, and by diet and statin therapy in patients with multiple risk factors. Patients with any clinical AVD (which includes diabetes) will need a statin to achieve an optimal LDL cholesterol (<100 mg/dL). The recent Heart Protection Study might revise our thinking further. Patients at high risk achieved a reduction in mortality and vascular events taking simvastatin 40 mg, even if they had a low baseline LDL value. Individuals with the metabolic syndrome and insulin resistance do not typically have a very high LDL, but rather have elevated triglycerides and a low high-density lipoprotein (HDL) cholesterol. They, too, need to be treated with a statin, first to achieve an appropriate LDL goal. This is insufficient if the triglyceride value exceeds 200 mg/dL. They should be treated to achieve a non-HDL cholesterol goal (equal to total cholesterol minus HDL cholesterol) that is 30 mg/dL higher than the LDL goal.