Cardiovascular disease, or coronary heart disease, is the most common cause of
morbidity and mortality in the developed world; over the course of this
century it will assume this dubious distinction in the developing world as well.
Many factors contribute to heart disease, including age, gender, family history,
hypertension, and diabetes: hyperlipidemia figures especially prominently as
such a risk factor. The risk of coronary heart disease in any given individual
increases with the number of risk factors in that person and the relative
severity of each factor. This cumulative risk is multiplicative and not simply
additive.
The detection of hyperlipidemia begins with the identification of patients at
high risk for hyperlipidemia and/or coronary artery disease. During the
evaluation process, the doctor must obtain a comprehensive dietary history of
these patients, because those already at risk for the disease can increase their
risk if they do not maintain an appropriate diet. Numerous guidelines have been
published that suggest ranges of serum lipid moieties that correlate with
relative risk of disease in individual patients. These guidelines form the
basis for primary and secondary prevention efforts in clinical practice.
Measurement or calculation of total cholesterol, low-density lipoprotein (LDL)
cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides is
crucial to accurate risk assessment and the prescription of certain diets
accordingly.
Excess dietary fat, perhaps especially saturated fat, contributes to
prevalent serum hyperlipidemia in high-risk populations. Dietary
interventions should serve as the mainstay of any attempt to reduce this burden
of disease in individual patients and in the general population. These
interventions should include the restriction of total fat, saturated fat, and
cholesterol, and an increase in the intake of complex carbohydrates and high-
fiber foods. Weight loss in overweight patients is a goal of a rational diet
and contributes to important reductions in LDL cholesterol.
