Therapeutic lifestyle changes and pharmaceutical care in the treatment of dyslipidemias in adults

Objective: To review each therapeutic lifestyle change (TLC) component listed in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) cholesterol guidelines and discuss how the guidelines can be used by pharmacists in the treatment of patients with dyslipidemias. Data Sources: Published guidelines and abstracts identified through PubMed (May 1987-March 2004), Medline (January 1966-March 2004), using the search terms cholesterol, hypercholesterolemia, dyslipidetnia, hyperlipidemia, diet, saturated fats, unsaturated fats, trans-fatty acids, overweight, obese, exercise, physical activity, program adherence, and guidelines, as well as the NCEP ATP III guidelines, the 2004 ATP III update, National Heart, Lung, and Blood Institute Obesity Guidelines, and Dietary Guidelines for Americans 2005. Study Selection: Performed manually by author. Data Extraction: Performed manually by author. Data Synthesis: TLC components are recommended in the NCEP ATP III guidelines for treatment of patients with dyslipidemias independent of medication use. Dietary modifications are the primary focus of TLC therapy. Saturated fat intake should be limited to less than 7% of total caloric intake and trans-fatty acid intake should be low for patients with dyslipidemias. Persons who are overweight or obese with dyslipidemias should reduce body weight through a combination of physical activity, total calorie reduction, and behavior therapy modifications. Conclusion: Pharmacists, given the proper training, can be effective at offering preventive pharmaceutical care for decreasing high blood cholesterol and the risk for coronary heart disease through patient counseling on TLC components as well as drug therapy in patients with dyslipidemias.