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Dyslipidaemia

INTRODUCTION

Established facts

  • Major risk factors for CAD include:

    • – ↑ LDL cholesterol + ↓ HDL cholesterol

    • – ratio LDLC/HDLC >4

  • Risk increases with increasing total cholesterol (TC) levels

  • TG levels >10 mmol/L increases risk of pancreatitis

  • Management should be correlated with risk factors

  • 10% reduction in total cholesterol gives 20% ↓ in CAD after 3 yrs

  • 1 mmol/L reduction in LDL (using a statin) reduces risk of CVS events by 20–25%. LDL is the prime atherogenic risk factor.

Investigations

  • Serum triglyceride

  • Serum cholesterol and HDLC and LDLC

  • TFTs if hypothyroidism suspected

Appropriate treatment goals

  • Total cholesterol <4.0 (esp. if high risk)

  • LDLC <2.0 mmol/L (<1.8 in high-risk patients)

  • HDLC >1.0 mmol/L

  • Non-HDLC <2.5 mmol/L

  • Triglycerides <2.0 mmol/L

Treat all risk factors.

Non-pharmacological measures

  • Dietary measures:

    • – Keep to ideal weight. Follow low carbohydrate diet (avoid sugar).

    • – Reduce fat intake, esp. dairy products and meat. Healthy fats ok.

    • – Avoid ‘fast’ foods and deep-fried foods

    • – Replace saturated fats with mono- or polyunsaturated fats

    • – Always trim fat off meat, remove skin from chicken

    • – Avoid biscuits and cakes between meals

    • – Introduce plant sterol-enriched milk, margarine or cheeses

    • – Ensure a high-fibre diet, esp. fruit and vegetables

    • – Keep alcohol intake to 0–2 standard drinks/d

    • – Drink more water

    • – Use approved cooking methods, e.g. steaming, grilling

    • – Highly elevated triglycerides can be lowered by no alcohol and reduction of carbohydrates

  • Regular exercise

  • Cessation of smoking

  • Cooperation of family is essential

  • Exclude secondary causes (e.g. hypothyroidism, type 2 diabetes, nephrotic syndrome, obesity, alcohol excess, esp. ↑ TG, specific diuretics)

Checkpoints

  • Diet therapy effective (TG ↓, LDLC ↓) within 6–8 wks

  • Continue at least 6 mths before consider drug therapy in all but the highest risk category

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Table D7 Patients requiring treatment (PBS guidelines)

Risk category

Initiate drug therapy if lipid level (mmol/L) is

Patients with existing symptomatic coronary heart disease, peripheral vascular disease and cerebrovascular disease

Patients with diabetes plus one of microalbuminuria; age >60; Aboriginal or Torres Strait Islander

Family history of coronary heart disease (one first-degree relative <45 years of age, or two <55 years)

Any level

Aboriginal and Torres Strait Islander patients with hypertension

Family history of coronary heart disease (one first-degree relative <60 years of age, or one second-degree relative <50 years)

Cholesterol >6.5 mmol/L

or

Cholesterol >5.5 mmol/L

and

HDL <1 mmol/L

Patients with HDL <1 mmol/L

Cholesterol >6.5 mmol/L

Patients not eligible under the above:

  • men 35–75 years

  • postmenopausal women up to 75 years

Cholesterol >7.5 mmol/L

or

Triglyceride >4 mmol/L

Patients not otherwise included in the above

Cholesterol >9 mmol/L

or

Triglyceride >8 mmol/L

PHARMACOLOGICAL MEASURES

Use these agents in addition to diet. All patients with CVD should be ...

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