Chapter 27: Antilipemic Drugs

The chapter explains atherosclerotic plaque development initiated by foam cell accumulation and establishes elevated low-density lipoprotein as the primary modifiable risk factor for coronary heart disease progression. Treatment algorithms from the American College of Cardiology and American Heart Association identify four distinct patient populations most likely to benefit from statin monotherapy: those with established atherosclerotic cardiovascular disease, extremely elevated low-density lipoprotein levels, diabetes mellitus diagnosis, or high ten-year cardiovascular event probability. Major pharmacologic classes are examined comprehensively: hydroxymethylglutaryl-coenzyme A reductase inhibitors reduce low-density lipoprotein cholesterol and modestly increase high-density lipoprotein while carrying risks of hepatotoxicity, muscle pain, and rhabdomyolysis; bile acid sequestrants bind intestinal bile acids to lower low-density lipoprotein but may elevate triglycerides and cause constipation; nicotinic acid decreases low-density lipoprotein and triglycerides while raising high-density lipoprotein but causes flushing and potential liver damage; and fibric acid derivatives effectively lower triglycerides and raise high-density lipoprotein yet increase gallstone formation and potentiate anticoagulant effects. Newer therapeutic options including cholesterol absorption inhibitors, proprotein convertase subtilisin-kexin type 9 antagonists, and bempedoic acid address resistant dyslipidemia. The chapter incorporates complementary approaches including plant-derived compounds and omega-3 polyunsaturated fatty acids alongside nursing interventions that encompass lipid panel assessment, hepatic and renal function monitoring, comprehensive dietary evaluation, and patient education regarding adherence, potential adverse effects, medication timing, and synergistic lifestyle modifications.