Q. Explain Therapy of Specific Lipid Disorders?

a) Very high LDL levels usually result from inherited disorders of lipoprotein metabolism and carry a high risk of premature atherosclerosis with attendant morbidity and mortality.

Hypothyroidism may be associated with markedly elevated LDL levels and should be ruled out in any patient presenting with elevated LDL level. Most of these patients respond to high dose statin therapy in addition to dietary restrictions. The addition of a bile acid sequestrant with and additional third agent often is warranted to achieve target levels. Ezetimibe is another agent that may prove useful in this group. Therapy should be begun early, and family members should be screened for hyperlipidemia. Patients with homozygous familial hyperlipidemia are deficient in LDL receptors and measures that reduce cholesterol absorption or act by LDL receptor upregulation are largely ineffective. These patients are treated with LDL apheresis and should be managed in tertiary care centers only.