CHOLESTEROL: Statins BEFORE THE DIET PLAN!

According to a survey of health insurance, the number of French taking medication against cholesterol (statin) reached five million. It would appear that the requirements are rarely consistent with the recommendations. Update on the management of dyslipidemia (blood lipid abnormalities).

1) Dyslipidemia refers to an abnormality of blood lipids, the most famous being the excess cholesterol (hypercholesterolemia) and excess triglycerides (hypertriglyceridemia).

2) Screening for dyslipidemia uses the dosages of serum lipids, including the determination of the concentrations of total cholesterol, triglycerides and HDL cholesterol (good "cholesterol"). In recent concentrations are known, LDL cholesterol ("bad" cholesterol) can be calculated (Friedewald formula). This screening should be performed in all adults at least once. If the result is normal, it is not necessary to renew.

3) The cardiovascular risk is determined in dyslipidemic patients, not only by the level of serum lipids, but even more by the presence of cardiovascular involvement and / or the presence of associated risk factors:

Age: 50 year old man or more, women 60 years or older.

The family history of premature coronary artery disease: myocardial infarction or sudden death before age 55 in the father (mother) or a relative of the first degree male (female).

A current or stopped smoking for less than 3 years.

A permanent high blood pressure treated or untreated.

A type 2 diabetes treated or not.

An HDL cholesterol lower than or equal to 0.40 g / l, irrespective of sex.

4) The LDL cholesterol is the decision setting the treatment of dyslipidemia: its reduction is the main objective of the management. Depending on the number of risk factors, the therapeutic goal is to obtain concentrations of less than a certain value of LDL-cholesterol:

no risk factors: LDL cholesterol should be less than 2.20 g / l;

a risk factor: LDL cholesterol should be less than 1.90 g / l;

two risk factors: LDL cholesterol should be less than 1.60 g / l;

three risk factors: LDL cholesterol should be less than 1.30 g / l;

secondary prevention (after a first cardiovascular event) or in patients at very high risk, LDL cholesterol should be below 1 g / l.

5) In the majority of patients with low cardiovascular risk, prescription drug treatment is not justified. The introduction of a dietary treatment is necessary as the basis of support. The dietary changes include four categories of measures: 1. limiting the intake of saturated fats (animal fats), in favor of mono or polyunsaturated fatty acids; 2. increased consumption of polyunsaturated omega 3 fatty acids (fish); 3. increased consumption of fiber and natural micronutrients (fruits, vegetables and grain products); 4. limitation of dietary cholesterol or use of foods enriched with plant sterols. At these recommendations is the need to limit alcohol consumption, weight control and correct excessive inactivity (30 minutes of walking per day minimum). This dietary treatment should be continued as long as possible.

6) Some dietary advice

Replace butter with vegetable oils (mono and polyunsaturated essential), by "soft" many ines that are not paper packaging (for saturated) or products enriched with plant sterols.

Avoid cold cuts, with the exception of lean ham.

Focus on fish at the expense of meat.

Limit consumption of the richest fat dairy products.

Do not eat more than two eggs a week.

Ensure adequate fiber intake, emphasizing the consumption of fruits, vegetables, bread, cereals and starches.

Alcohol consumption is acceptable (no more than 1-6 drinks per week). However, alcohol intake should be controlled in hypertriglyceridemia (and overweight).

Be careful not to create an unbalanced diet, particularly calcium deficiency.

7) When drug therapy is indicated, that is to say in the event of failure of the diet after three months, most often prescribed statin. This treatment should start with the lowest dosage. Monitoring the effectiveness and tolerance should be performed between one and three months after starting treatment.