Dyslipidemia Patient Education

• Patients with dyslipidemia are advised to have lifestyle modification regardless of their risk profile 
  • ASCVD risk is reduced by a healthy lifestyle in all age groups

Dietary Recommendations

• Recommended LDL-C-lowering diet:
  
  • Increase vegetables, fruits, whole grain products, low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oil, and nuts
  • Limit red meat, sweetened beverages, chocolates and sweets 

• Dietary fat should range from 20-30% of total calories
  
  • Saturated fat should be <10% of total calories
  • Cholesterol should be <300 mg/day
  • Polyunsaturated fat can be up to 6-10% of total calories
  • Monounsaturated fats: Total Fats - (Saturated + Polyunsaturated fats)
    
    • May comprise up to 20% of caloric intake
  • Reducing trans fat (<1% of total calories) may decrease LDL-C

• Reduce sodium consumption to ≤2,400 mg/day
  
  • Decreasing sodium intake to 1,150 mg/day may reduce blood pressure in 30- to 80-year-old patients with or without hypertension by up to 4/2 mmHg
  • When reduced to 1,000 mg/day, studies showed decrease in cardiovascular disease (CVD) events by 30%

• Carbohydrates should range from 45-55% of total energy intake
  
  • Lower carbohydrate intake if with high triglycerides and low HDL-C
  • Source of carbohydrates should be mainly from complex carbohydrates
  • Includes grains (especially whole grains), fruits and vegetables

• Fiber: 25-40 g/day of total dietary fiber
• Protein should be 15-20% of total calories
• Total calories should be enough to balance energy intake and expenditure to maintain body mass index (BMI) for Asian adults of 18.5-23 kg/m² or BMI for European adults of 20-25 kg/m²
• Moderate intake of fatty fish that is boiled, broiled or baked but not fried
  
  • Up to 2 servings of fatty fish per week for the general population is recommended while coronary artery disease (CAD) patients should consume 1 gram of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) through fatty fish or high-quality dietary supplements
  • Omega-3 fish oil supplements may be considered to treat severe hypertriglyceridemia (triglycerides >500 mg/dL) and for secondary prevention of CVD

Increase Physical Activity

• Physical activity can reduce risk for CVD
• Reduce sedentary time
• Moderate aerobic exercise (eg brisk walking, swimming, jogging, cycling) 3-4x/week (ideally daily) for 30-40 minutes at each session is recommended
• Aerobics may reduce LDL-C levels in adults by 3-6 mg/dL and non-HDL-C by 6 mg/dL
• Studies show that resistance training helps lower LDL-C, triglycerides and non-HDL-C levels by 6-9 mg/dL
• Especially helpful in patients with metabolic syndrome
• Muscle-strengthening exercise is recommended ≥2 days/week in addition to aerobic exercises
  • Studies have shown that weight and resistance training may benefit patients with insulin resistance syndrome regardless of body fat or aerobic fitness

Weight Loss

• Achieved mainly by dietary changes and exercise
• Weight loss should be gradual
  
  • 10% of body weight in 6 months
• Waist circumference maintained at <90 cm for men and <80 cm for women

Alcohol Intake

• ≤2 drinks/day (up to 20 g/day) for men
• ≤1 drink/day (up to 10 g/day) for women

Smoking Cessation

• Patient must quit immediately
• Has beneficial effect on overall cardiovascular risk and specifically on HDL-C levels

Intensifying Lifestyle Modifications

Increasing Viscous Fiber

• Therapeutic option to help lower LDL-C
• Viscous (soluble) fiber is found in oats, pectin-rich fruit, barley, psyllium, beans, etc
  
  • 5-10 g/day can reduce LDL-C levels by ~5%

Plant Stanols/Sterols

• Sterols are isolated from soybean and tall pine tree oils
• Lipids are needed to solubilize stanol or sterol esters
  
  • Found in commercial margarines, where available
• 2 g/day lower TC and LDL-C by 7-10%
• Help reduce cholesterol absorption

Referral to Dietitian

• Consultation with qualified professional for medical nutrition therapy
• List foods rich in omega-3 fatty acids EPA and DHA