dyslipidemia
DYSLIPIDEMIA
Dyslipidemia is having an abnormal amount of lipids or fats in the blood.
Lipid profile is obtained from an individual with diabetes mellitus, coronary heart disease, cerebrovascular disease, peripheral arterial disease or other coronary heart disease risk factors or from an individual with family history or clinical evidence of familial hypercholesterolemia.
Plasma lipids are total cholesterol, high-density lipoprotein cholesterol, trigylcerides, and low-density lipoprotein cholesterol.
Evaluation of lipid profile must be performed in parallel with the risk assessment of coronary heart disease.

Lifestyle Modification

  • 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 <7% of total calories
    • Cholesterol should be <200 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 50-60% of total calories
    • 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: ≥20-30 g/day or 10 g/1000 kcal/day
  • 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 18.5-24.9 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
    • Studies have shown that 2-4 g of fish oil daily can help reduce triglycerides levels by ≥25% while resulting in slight elevations in LDL-C and without significant effect on HDL-C levels

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

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

Moderate 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

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
  • 2-3 g/day can reduce LDL-C by 6-15%
  • 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
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