The treatment of hyperlipidemia requires two approaches:
Therapeutic lifestyle changes (TLC) and medications. To achieve target LDL levels, most patients need both approaches simultaneously.
TLCs encompasses increased physical activity, ideal weight maintenance, and a diet that encompasses a reduced intake of saturated fat (<7 per cent of total calories) and cholesterol (<200mg/day). Other TLCs are listed in table. It is essential to reduce saturated fat intake for patients with metabolic syndrome. A fat intake of 30 per cent to 35 per cent maybe optimal for reducing lipid and nonlipid risk factors. High carbohydrate diets may worsen the lipid abnormalities in these patients. Dietary carbohydrates should predominantly be derived from foods rich in complex carbohydrates, such as whole grains, fruits and vegetables. Daily intake of 5 to 10 G of viscous fiber reduces LDL levels by approximately 5 per cent and he use of plant stanols and Sterols (2 to 3 g/day) by another 6 per cent to 15 per cent. TLCs can achieve an almost 30 per cent reduction in LDL-C in highly motivated individuals and should form the cornerstone of all preventive activity LDL-C should be measured 6 weeks after initiating TLC diet, and if the goals are not met, intensification of TLCs and use of plant sterols or stanols should be considered. Referral to a dietitian for education and dietary counseling is often invaluable at this stage. If after 3 months of TLCs, adequate control is not achieved, drug therapy should be considered.