Recommendations about how to deal with patient suffering from dyslipidemia.
Please find below the most important information mentioned in this document.
The Afssaps recommends first to perform a lipidic check-up, which:
- must be performed after 12h of fasting
- must be based on the Exploration of a Lipidic Anomaly (ELA) which aim is to determine the concentrations of:
- total Cholesterol
If triglycerides are > 4 g/l (4,6 mmol/l), it is hypertriglyceridemia .
If LDL Cholesterol < 1,60 g/l (4,1 mmol/l), triglycerides < 1,50 g/l (1,7 mmol/l) and HDL-Cholesterol > 0,40 g/l (1 mmol/l), the lipidic check-up is considered as normal with a patient having no risk factor. Thus, it is no necessary to repeat this check-up.
Assessment of the cardio-vascular risk
To better adjust the treatment, the Afssaps recommends to look for cardio-vascular risk factors.
The calculation of these factors allows the identification of three risk levels :
- Weak risk : no risk factor associated to dyslipidemia;
- Intermediate risk : at least one risk factor associated to dyslipidemia;
- High risk : antecedents of established cardio-vascular disease or equivalent risks.
Therapeutic objectives vary:
- According to the vascular status of the patient,
- According to the number of related cardio-vascular risk factors .
Here are the rates of LDL-cholesterol not to exceed taking into account the aforementioned factors.
Dyslipidemic patient treatment
- For patient having LDL-cholesterol > 1,60 g/l :
- Dietetic approach,
- Having a regular physical activity,
- Dealing with risk factors (smoking, diabetes, etc.).
- For dyslipidemic patients as primary prevention : a monotherapeutic dietetic treatment.
- For at least 3 months,
- To be carried on even if the therapeutic objective has been reached,
- To be completed by a medicinal treatment if the therapeutic objective was not reached.
- For patients with high cardio-vascular risk :
- A lipopenic medication treatment, in small posology to start with, to be increased in view of the efficiency and the tolerance.
- A nutritional prescription,
- Correction of the other risk factors.
Modifications of the diet consist in :
- Limit the intakes of saturated fatty acid and food cholesterol
- Increase the intakes of poly-saturated fatty acid omega 3, fibers and micronutriments
Afssaps recommends to associate this diet to a regular physical exercices, in order to avoid a drug treatment.
These are the main drug classes as indicated by Afssaps to deal with dyslipidemia:
- Cholesterol intestinal absorption inhibitor,
- Nicotic acid.
When a drug treatment is prescribed, it is mainly with statin, except for the following cases:
- Intolerance to statins ;
- LDL-cholesterol < 1 g/l associated to high triglycerides and a low HDL-cholesterol;
- Isolated acute hypertriglyceridemia (TG > 4 g/l).
Recommendations about how to deal with patient suffering from dyslipidemia
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