[Treatment for dyslipidemia--a strategy for the prevention of atherosclerosis].

Plasma cholesterol levels in the Japanese people gradually increased until 1990, possibly due to the increase in dietary cholesterol. Japan Atherosclerosis Society Guidelines for the prevention of atherosclerotic cardiovascular diseases were released in 2012. The diagnostic values of LDL-C, TG and HDL-C for dyslipidemia are >or= 140 mg/dL, >or=150 mg/dL and <40 mg/dL, respectively. The guidelines emphasize that these figures do not indicate a need to start drug therapy, but are only for dyslipidemia screening. The set point of LDL-C for the prevention of atherosclerosis falls with the number of risk factors. The guidelines recommend LDL-C calculated from the Friedewald formula, because homogenous assay kits for LDL-C still have problems in terms of accuracy. It is obvious that long-term excessive cholesterol consumption affects the plasma cholesterol level. It is thus necessary to restrict dietary cholesterol intake, at least for hypercholesterolemic patients. If the effect of dietary therapy is insufficient, drug therapy should be taken into consideration. Statins, HMG-CoA reductase inhibitors, are most commonly used worldwide for hypercholesterolemic patients and fibrates are effective for hypertriglyceridemia. When we use these two drugs in patients with type IIb dyslipidemia, we should pay attention to side effects, including rhabdomyolysis. On the other hand, ezetimib is a new type of cholesterol-lowering drug and is an inhibitor of cholesterol transport in the small intestine. Thus, the combination of ezetimib and statins can reduce LDL-C more than therapy with each drug alone.