OTHER THERAPEUTIC OPTIONS

Gene Therapy

Gene therapy is several years from clinical use. It may prove ideal for use in patients with genetic disorders such as familial hypercholesterolemia.

Plasmapheresis

Plasmapheresis has become the most common nonpharmacologic, non-dietary treatment of severe hypercholesterolemia. In nonselective plasmapheresis, the patient's plasma is replaced with salt-free human albumin. This action reduces triglyceride levels dramatically and decreases the risk of pancreatitis.
 
Surgical Modalities

Partial ileal bypass that eliminates the reabsorption of bile acids at the distal portion of the ileum has been shown to be a viable treatment in some cases of severe dyslipidemia. Portacaval shunt and liver transplantation have been shown to be effective in treating severe hypercholesterolemia.

SPECIAL ISSUES

Screening for Hypercholesterolemia
in Children

Children in families with familial hypercholesterolemia and early CAD have higher cholesterol levels, and childhood cholesterol levels are significant predictors of adult levels. All children older than 2 years would benefit from a diet that is low in saturated fat. Population level prevention and lifestyle interventions should still be favored for young adults.

Managing Dyslipidemia in Women

CAD does occur in premenopausal women, usually in association with multiple genetic and environmental risk factors, such as in patients with familial forms of dyslipidemia or in diabetic patients who smoke cigarettes. After menopause, some women develop the dyslipidemia, characterized by visceral obesity, insulin resistance, hypertension and dyslipidemia.

Managing Dyslipidemia in Older Patients

Age is one of the significant risk factor for the development of atherosclerosis. A clinical trial indicates that statin therapy is effective in the elderly. Attention to other concomitant diseases and the nutritional state, as well as to capabilities of the elderly is important considerations in the management of older patients with dyslipidemia.

THE CHALLENGE OF IMPLEMENTATION

Enormous challenges remain regarding translation of the current evidence base into practice. The obstacles to implementation of current evidence based prevention and

treatment of dyslipidemia include economics, education, physician awareness and patient adherence to recommended regimens. Future goals in the field of treatment of dyslipidemia should include application of the current knowledge regarding risk factor management & where appropriate drug therapy is required.

Reference _____________________________
 

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