Hyperlipidemia

The situation:

Hyperlipidemia is a group of disorders encompassing abnormal regulation of cholesterol and triglycerides, the two main sources of fat in our blood stream. Most persons in the United States have a form of hyperlipidemia characterized by high LDL-Cholesterol (bad cholesterol). In many cases this is coupled with low HDL-Cholesterol (good cholesterol). Many persons, especially those with Diabetes or obesity also have high Triglycerides. All of these abnormalities have been associated with increased risk for cardiovascular disease.

“Normal” or healthy total cholesterol levels are < 130 mg/dl. All non-human mammals and many simple tribal cultures maintain this level of cholesterol through healthy eating and regular exercise. (fig 1)

Americans, on the other hand have an average total cholesterol of atround 240 mg/dl! For years we have know that such a level increases the risk of cardiovascular death by more than twice. (fig 2)

The sobering truth is that having untreated high cholesterol (at the US average) by age 22 leads to more than a six-fold increase in cardiovascular events by age 60. (fig 3)

The problem:

Despite over 20 years of public education on cholesterol, most patients are still undiagnosed or inadequately treated. Less than one in 7 patients who should be treated (according to NCEP guidelines) are actually being treated (fig 4)

Further, of those persons with high risk for, or established coronary heart disease who are being treated with either diet and exercise or medication far fewer than half have achieved the NCEP goals. (fig 5)

Even among those with KNOWN atherosclerosis:

• Two thirds do not receive treatment for hypercholesterolemia
• One-third are not screened for hypercholesterolemia based on NCEP II guidelines

Managing an asymptomatic condition such as hyperlipidemia is difficult for a busy primary care physician.

• over 50% of patients stop their medicines by 6 months (fig 6)
• Only 14% of patients who are treated by primary care physicians achieve an LDL goal based on NCEP II guidelines (now stricter in NCEP III)
• Only 4% of patients with hypercholesterolemia cared for in community settings were both treated and controlled as apposed to 50% of patients with hypertension

The Santé solution:

At Santé, we will work with you to achieve your cholesterol goals. Study after study shows that whether you are trying to prevent your first cardiovascular event (primary prevention) or avoid having another event (secondary prevention), lowering of LDL-Cholesterol dramatically reduces events. For our patients with known atherosclerosis we aim for an LDL-Cholesterol < 70 mg/dl. (fig 7)

For our patients without known atherosclerosis, we aim for an LDL-Cholesterol < 100 mg/dl. (fig 8)

Fundamentally, we believe aggressive lipid management is the only option for our patients. (fig 9)

Unlike many physicians, we consider lipid management our mandate and will work with you until we achieve the results you deserve.