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.
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