hyperlipidaemia
hyperlipidaemia
Introduction
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atherosclerosis in the carotid arteries also plays a major role in
stroke (CVA).
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Lipoproteins
Target concentrations for minimisation of atherosclerosis (2008)
A meta-analysis of randomised trials of statins showed that for each 1 mmol/L reduction of LDL cholesterol (which generally equates to a 20% reduction of LDL cholesterol) there is a 20–30% relative risk reduction of coronary heart disease events.
Lowering the LDL a further 30% or so, or an extra 1 mmol/L, reduces coronary heart disease events by a further 20–30%.
Reducing LDL cholesterol to below appropriate targets is more important than the method or specific drug used to achieve the reduction.
asymptomatic patients with low risk of IHD
known coronary artery disease
Lowering cholesterol through lifestyle changes
diet
replacing saturated fat with either carbohydrate or foods rich in mono- or polyunsaturated fats and high fibre foods is effective in lowering LDL cholesterol.
avoid baked foods containing trans fatty acids, such as pies, pastries, cakes and biscuits.
response to diet can vary considerably and is usually seen in 4−6 weeks
some patients are very responsive and can have up to 30% lowering of LDL cholesterol
diets to consider:
Mediterranean-type diets, as found in Greece, Italy and Spain.
vegetarian-like, high in nuts and olive oil, vegetables and pasta which was cooked al dente. Fruit was eaten frequently along with some cheese, wine and nuts.
after a myocardial infarction, a Mediterranean-type diet compared to a usual low fat diet is associated with a 50% relative reduction in mortality. This is independent of any change in serum cholesterol.
low in total fat such as in Japanese cuisine
high intake of fish, particularly fish rich in marine omega-3 fatty acids
weight loss
For every kilogram decrease in body weight, LDL cholesterol decreases by 0.02 mmol/L, triglycerides decrease by 0.015 mmol/L and HDL cholesterol increases by 0.14 mmol/L.
losing 5–10 kg is achievable and can make a difference to the risk profile.
exercise
nutraceuticals
plant sterols
On average plant sterols reduce LDL cholesterol by 10%, but this may vary from 0 to 30%. They have an additive effect to drug therapy.
A dose of 2–4 g of plant sterols is needed, which equates to at least four teaspoons of plant-enriched margarine per day.
soluble fibre
omega-3 fatty acids
Pharmacologic lowering of cholesterol
statins
HMGCoA reductase inhibitors, 'statins', are the first drugs to use. They are extremely efficacious and more than 90% of patients can tolerate them with negligible or no adverse effects.
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In approximately 75% of the patients who cannot tolerate even half the usual dose of statins, ezetimibe can be effective.
Ezetimibe 10mg/d inhibits the absorption of dietary cholesterol.
in patients on maximal statins without adequate effect, adding ezetimibe can often lead to a synergistic lowering of LDL cholesterol by an extra 20–25%.
Rx of hypertriglyceridaemia
diet rich in mono- and polyunsaturated fat and low glycaemic index carbohydrate food
caloric restriction (leading to weight reduction) and exercise.
consideration of marine omega-3 fatty acids (fish oil) and fibrates.
References
hyperlipidaemia.txt · Last modified: 2020/04/29 14:26 by gary1