A variety of strategies are used to lower lipid levels in patients with identifiable cardiovascular risk. Controversy exists as to which patient populations should be offered aggressive intervention based on serum lipid results. Most experts agree that the number of LDL particles (LDL-P) should be considered worrisome for future risk if this is elevated, even in the setting of a normal LDL-cholesterol (LDL-C) value.
Agents used to “lower cholesterol” have varying effects on LDL-C and LDL-P as listed below:
Therapies with greater affect on reduction of LDL-C over LDL-P
1. statin
2. ezetimbe
3. bile acid sequestrants
4. estrogen replacement
5. anti-retrovirals
6. low-fat, high carb diet
Therapies with greater affect on reduction of LDL-P over LDL-C
1. niacin
2. omega 3 fatty acides
3. mediterranean diet
4. pioglitzone
5. fibrates
6. exercise
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