Dealing with patient suffering from dyslipidemia (Afssaps)

June 2017

Recommendations about how to deal with patient suffering from dyslipidemia.
Please find below the most important information mentioned in this document.

Lipidic check-up



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
    • triglycerides
    • HDL-Cholesterol
    • LDL-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


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

General outline


Afssaps recommends:
  • 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.

Dietetic treatment


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.

Medicinal treatment


These are the main drug classes as indicated by Afssaps to deal with dyslipidemia:
  • Statins,
  • Fibrates,
  • Resins,
  • 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).

Sources


Recommendations about how to deal with patient suffering from dyslipidemia

Photographic copyright: Rohit Seth - Fotolia.com

Related


Dyslipidémie (Afssaps)
Dyslipidémie (Afssaps)
Tratamiento del paciente dislipidémico
Tratamiento del paciente dislipidémico
Behandlung von Patienten mit Dyslipidämie
Behandlung von Patienten mit Dyslipidämie
Latest update on April 14, 2010 at 09:04 AM by owliance.en_ctrl_001.
This document, titled "Dealing with patient suffering from dyslipidemia (Afssaps)," is available under the Creative Commons license. Any copy, reuse, or modification of the content should be sufficiently credited to CCM Health (health.ccm.net).