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Primary prevention of Dyslipidemia

Mar 24, 20253 min read

Primary Prevention

  • LDL-C
    ≥190 mg/dL

  • Diabetes
    LDL-C 70–189 mg/dL
    Age 40–75 y

  • ≥7.5% estimated 10-y ASCVD risk
    and age 40–75 y

<20 years  only treat if familial dyslipidaemia 20-40 years  Consider treat if LDL ≥4.1 (160) + FH premature ASCVD

40 - 75/85yrs we calculate the 10 year risk ASCVD , but if DM give statin. ( ≥85 years NICE) (≥75 ACC)  no need to calculate risk just assess clinically the need and discuss

Guidelines for Primary Prevention

Lifestyle Changes for Preventing Cardiovascular Disease

  1. Person at risk of cardiovascular disease
  2. Alcohol
  3. Diet
  4. Physical activity
  5. Smoking
  6. Weight management
  7. Lipid modification therapy

Diet Therapy

  • I LOST 1 KG THIS WEEK
  • TIME TO REWARD MYSELF!

Diet Therapy

(Always initiated firstly in the management. Except patients with familial hypercholesterolemia and Statin benefit group in which both drugs and diet should begin together.)

  • Total fat restriction → ↓hypertriglyceridemia
  • Cholesterol & Saturated fat → ↓Hypercholesterolemia (LDL)
  • Decrease CHO (Sucrose & simple sugars) → ↓VLDL.
  • Increase dietary fibers (oat or rice bran) → ↓LDL

American Heart Association

  • Increase vegetables, fresh fruit, cereals, whole grain.
  • No alcohol → ↓ Hypertriglyceridemia
  • Decrease caloric intake and stabilization of weight.
  • Total fat calories should be 20-25% with saturated fat < 8%.

Exercise

  • Aerobic physical activity
  • Minimum 3-4 sessions per week
  • Lasting on average 40 minutes per session
  • Involving moderate-to-vigorous intensity physical activity.
  • ▼TG, ▼VLDL-C, and ▲HDL-C

Effect of Impact Exercise on Cholesterol levels 12-month follow-up

Modrate: Brisk walking (2.4-4mile per hour), bikng (5-9 mph), active yoga, recreational swimming.

Vigorous: Jogging/ running, biking (>10mph), swimming labs, single tennis

Dyslipidemia Management

Weight Loss

  • Weight loss improves the plasma lipoprotein profile.
  • Reductions in LDL-C and VLDL-C
  • Management options:

We recommend adjunctive pharmacotherapy for weight loss and weight-loss maintenance for individuals with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with adiposity-related complications, to support medical nutrition therapy, physical activity and psychological interventions. Options include liraglutide 3.0 mg, naltrexone-bupropion combination and orlistat.

Figure 12: BMI and lipid risk factors for men in the Framingham Offspring Study.

Recommendation

  • Assess ASCVD Risk in Each Age Group
  • Emphasize Adherence to Healthy Lifestyle

Age 0-19 y

  • Lifestyle to prevent or reduce ASCVD risk
  • Diagnosis of Familial Hypercholesterolemia → statin

Age 20-39 y

  • Estimate lifetime risk to encourage lifestyle to reduce ASCVD risk
  • Consider statin if family history of premature ASCVD and LDL-C ≥160 mg/dL (≥4.1 mmol/L)

Age 40-75 y and LDL-C ≥70-<190 mg/dL (≥1.8-<4.9 mmol/L) without diabetes mellitus

  • 10-year ASCVD risk percent begins risk discussion

Risk Calculation

  • LDL-C ≥190 mg/dL (≥4.9 mmol/L)

    • No risk assessment; High-intensity statin (Class I)

  • Diabetes mellitus and age 40-75 y

    • Moderate-intensity statin (Class I)

  • Diabetes mellitus and age 40-75 y

    • Risk assessment to consider high-intensity statin (Class IIa)

Age >75 y

  • Clinical assessment, Risk discussion

<20 years  only treat if familial dyslipidaemia

20-40 years  Consider treat if LDL ≥4.1 (160) + high lifetime ASCVD risk / FH premature ASCVD

We treat 40-75/85 we calculate the 10 year risk ASCVD percent and act accordingly.

( ≥85 years NICE) (≥75 ACC)  no need to calculate risk just assess clinically the need and discuss

Pooled Cohort Equation

US: ASCVD Risk Score Calculator: http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

Graph View

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