Once a person has been tested and found to have dyslipidemia, it is a good idea to evaluate their clinical picture for evidence that they have end organ damage, such as coronary artery disease, stroke, or peripheral vascular disease. All patients with elevated LDL cholesterol should have a reduction in dietary fat and cholesterol content, maintenance of ideal body weight, and a high fiber diet. Exercise seems to help in mild cases but the high risk patient should have consideration for statin drug therapy. Statins are the main treatment of choice for dyslipidemia, largely because they are known to reduce morbidity and mortality of heart disease. There are many statin drugs that work in the same way. Other options include bile acid sequestrants that block bile acid reabsorption in the intestines, cholesterol absorption inhibitors like ezetimibe, and PCSK0 monoclonal antibody therapy. Patients with severe disease from homozygous familial hypercholesterolemia can take mipomersen or lomitapide, which block the synthesis of apo B in the liver in order to decrease the LDL cholesterol. High triglycerides are often treated with lifestyle changes, although fibrates will reduce the triglyceride level by half. Statin drugs will also help, as will omega-3 fatty acids. Apo CIII inhibitor drugs are not available everywhere but are used in severely elevated triglyceride circumstances. Low HDL is difficult to treat and exercise is most recommended as a way to combat this problem. Nicotinic acid and fibrates may also help to a slight degree.
PERIPHERAL VASCULAR DISEASE The main cause of peripheral vascular disease is atherosclerosis of the lower legs, leading to ischemia of the toes first and then proximally over time. It is often asymptomatic with the first sign being leg or calf pain with exercise. As the disease progresses, the pain will worsen with decreasing levels of exercise and there will be findings of cyanosis, hair loss, skin atrophy, ischemic leg ulcers, and gangrene. The major cause of death is some other type of cardiovascular disease, such as stroke or heart attack. The major risk factors are hyperlipidemia, diabetes, high blood pressure, smoking, older age, diabetes, male gender, and obesity. Peripheral arterial disease is a manifestation of systemic atherosclerosis, affecting other body areas as well.
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