Dealing with patient suffering from dyslipidemia (Afssaps)

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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

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