Hyperlipoproteinemia drug therapy

Type V hyperlipoproteinemia requires stringent restriction of dietary fat intake. Drug therapy with fibrates or niacin is indicated if the response to diet alone is inadequate. Medium-chain triglycerides, which are absorbed without chylomicron formation, may be used as a dietary supplement for caloric intake if needed for both types I and V. 

The answer is a. (Hardman, pp 875-898.) In type I hyperlipoproteinemia, drugs that reduce levels of lipoproteins are not useful, but reduction of dietary sources of fat may help. Cholesterol levels are usually normal, but triglycerides are elevated. Maintenance of ideal body weight is recommended in all types of hyperlipidemia. Clofibrate effectively reduces the levels of VLDLs that are characteristic of types 111, IV, and V hyperlipoproteinemia administration of cholestyramine resin and lovastatin in conjunction with a low-cholesterol diet is regarded as effective therapy for type 11a, or primary, hyperbetalipoproteinemia, except in the homozygous familial form. 

A decrease in serum cholesterol levels results in a decrease not only in the lipid content but also in the size of experimentally induced atherosclerotic lesions. Evidence of this association in man has been demonstrated by coronary angiography. " Human femoral atherosclerosis regressed in response to diet and/or drug therapy (clofibrate, NA, or clofibrate in combination with neomycin). "> The degree of retardation of atherosclerosis was directly correlated with the decrease in serum cholesterol levels. " Regression in patients with Type IV hyperlipoproteinemia was also associated with the decrease in serum triglyceride levels however, no such correlation was found in another study. ... 

Patients with type III hyperlipoproteinemia exhibit increased plasma cholesterol and triacylglycerol and the presence of 6-VLDL. Dysbetalipoproteinemics are prone to premature vascular disease, eruptive xanthomas on elbows and knees, and planar xanthomas in the palmar and digital creases. These patients respond well to therapy. Dietary therapy is preferred, but drug therapy (see below) may also be necessary. 

If dietary therapy is unsuccessful, drug therapy should be employed. Five classes of drugs are available for treatment of hyperlipoproteinemias their effects are due to decreased production or enhanced removal of lipoprotein from plasma. 

Type III hyperlipoproteinemia may be treated with fibrates or niacin. Although fibrates have been suggested as the drugs of choice, niacin is a reasonable alternative because of the lack of data supporting a cardiovascular mortality benefit from fibrates and because of their potentially serious adverse effects. Fish oil supplementation may be an alternative therapy. 

Treatment Various drugs are available that have different mechanisms of action and effects on LDL (cholesterol) and VLDL (triglycerides) (A). Their use is indicated in the therapy of primary hyperlipoproteinemias. In secondary hyperlipoproteinemias, the immediate goal should be to lower lipoprotein levels by dietary restriction, treatment of the primary disease, or both. 

Therapy - The treatment of atherosclerosis, although somewhat empirical, has advanced steadily over the past few years aided materially by the developments of (1) phenotyping of hyperlipoproteinemia, (2) accumulation of reliable information on various dietary regimens and (5) the availability of hypo-lipemic drugs. Thus, Levy and coworkers have been able to report that the treatment of familial hypercholesteremia has shifted from a frustrating to an eminently treatable problem. 

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