Cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) increase a person's risk of developing cardiovascular disease (CVD). In contrast, high density lipoprotein cholesterol (HDL-C) confers protection against cardiovascular diseases, reducing the risk as HDL-C increases. Therefore, it is clear that the term hyperlipidemia, which was previously used to describe disorders of lipoprotein metabolism, is inappropriate.
Dyslipidemia
It is more appropriate to use the term dyslipidemia, which encompasses abnormally high levels of specific lipoproteins, e.g., LDL-C, and abnormally low levels of other lipoproteins, e.g., HDL-C, as well as disorders in the composition of various lipoproteins. lipoproteins.
Disorders of lipoprotein metabolism.
Causes
Primary dyslipidemia
Up to 60% of the lipid variability in fasting cholesterol can be genetically determined, although expression is often influenced by interaction with environmental factors. Common family (genetic) disorders can be classified as:
It causes primary hypercholesterolemia, such as familial hypercholesterolemia, in which LDL-C is elevated, mixed primary hyperlipidemias (combined) in which both LDL-C and triglycerides are elevated, primary hypertriglyceridemia, and type III hyperlipoproteinemia , familial lipoprotein, lipid lipase deficiency and the apopoyence of familial lipoprotein lipase. deficiency
Secondary dyslipidemia
Dyslipidemias that occur as a result of a series of disorders, the indiscretion of the diet or as a side effect of drug therapy account for up to 40% of all dyslipidemias. Fortunately, lipid abnormalities in secondary dyslipidemia can often be corrected if the underlying disorder is treated, effective dietary advice is implemented, or the causative drug is withdrawn. Occasionally, a disorder may be associated with dyslipidemia, but not the cause. For example, hyperuricemia (gout) and hypertriglyceridemia coexist in approximately 50% of men. In this particular example, neither is the cause of the other and the treatment of one does not solve the other. There are, however, two notable exceptions to the rule with this example: nicotinic acid and fenofibrate. Both drugs reduce triglyceride levels, but nicotinic acid increases the levels of urate, while fenofibrate reduces them by an independent uricosuric effect.
The drugs
Several drugs can negatively affect the serum concentrations of lipids and lipoproteins: antihypertensive agents. , Oral contraceptives, corticosteroids, inducers of hepatic microsomal enzymes, risk assessment of ciclosporin
Primary prevention
In patients without evidence of coronary heart disease or other major atherosclerotic disease, there are a number of CVD risk prediction charts, including those produced by the Joint British Society (JBS2) (British Hypertension Society, 2009) for men and women. JBS2 recommends that all adults over 40 years of age, with no history of CVD or diabetes, and not receiving treatment for high blood pressure or dyslipidemia, should have opportunistic examinations every 5 years in primary care. The cardiovascular risk calculated using tables JBS2 is based on the number of cardiovascular events expected over the next 10 years in 100 women or men with the same risk factors as the individual being evaluated.
Secondary prevention
Patients with CVD and TC levels> 4 mmol / L and LDL-C> 2 mmol / L are the most likely to benefit from treatment with lipid-lowering agents. Typical of the individuals that fall into this category are patients with a history of angina pectoris, myocardial infarction, acute coronary syndrome, coronary artery bypass graft, coronary angioplasty or cardiac transplant, as well as patients with evidence of atherosclerotic disease in others. Vascular beds such as patients-stroke or TIA, and those with peripheral arterial disease.
Changes in lifestyle
When the decision is made to start treatment with a lipid-lowering agent, other risk factors should also be addressed, as appropriate, such as smoking, obesity, high alcohol consumption and lack of exercise. Underlying conditions, such as diabetes mellitus and hypertension, should be treated accordingly.
Changes in lifestyle lifestyle objective No smoking Maintain ideal body weight (BMI 20-25kg / m2) Avoid central obesity Reduce the total intake of fats in the diet to? 30% of the total energy intake Reduce the intake of saturated fats to? 10% of total fat intake Reduce dietary cholesterol intake to <300 mg / day Replace saturated fats with a higher intake of monounsaturated fats Increase the intake of fresh fruits and vegetables by at least five servings per day Eat fish regularly and other sources of omega-3 fatty acids (at least two servings of fish each week) Limit alcohol intake to <21 units / week for men and <14 units / week for women Restrict salt intake to <100 mmol day (<6 g sodium chloride or <2.4 g sodium / day) Perform regular aerobic exercise at least 30 min / day, most days of the week Avoid excessive consumption of coffee or other products containing caffeine
Treatment
The drugs
If a person is found to be at risk for CVD (primary prevention), it may be appropriate to perform a trial of changes in diet and lifestyle for 3 to 6 months. This rarely achieves the required effect on the lipid profile and medication therapy is required. However, this should not negate a sustained effort on the part of the individual to make appropriate adjustments in diet and lifestyle. In an individual who requires treatment for secondary prevention, a delay of several months to begin treatment is not appropriate and treatment will usually begin immediately with a lipid-lowering agent.
The treatment usually includes:
a hypolipidemic agent such as simvastatin 40 mg / day (or an alternative), but no treatment objectives have been established with personalized information on modifiable risk factors, such as physical activity, diet, alcohol consumption, weight and strict control of diabetes. Tips to quit smoking tips and treatment to achieve blood pressure below 140 mmHg systolic and 90 mmHg diastolic
Article reference: http://www.healthbeautytips.in/dyslipidemia-causes-risk-assessment-lifestyle-changes-treatment/
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