Dyslipidemia

Management

In patients with coronary heart disease or other atherosclerotic disease, the target LDL cholesterol level is 100 mg per dL (2.60 mmol per L) or less. If the LDL level in a patient with coronary heart disease does not exceed 100 mg per dL, the patient should begin the step I diet, engage in regular physical activity, and quit smoking. This group should have their lipoprotein levels checked once a year. Premenopausal women and men 35 years or younger who have dyslipidemia but no other risk factors for coronary heart disease or a genetic predisposition are considered to be at low risk.

Lifestyle Modifications

The NCEP guidelines recommend dietary changes, exercise, and weight loss as the cornerstones of dyslipidemia treatment. 12 According to the NCEP cut points, these basic interventions may be enough to treat up to 90% of people with dyslipidemia. 16 A 1% reduction in total cholesterol can reduce a person’s risk of coronary heart disease by 2%. 17 Smoking cessation and the reduction of other modifiable risk factors are critical components of coronary heart disease prevention.

EXERCISE AND WEIGHT REDUCTION

Obesity raises cholesterol levels in the very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) fractions, raises triglycerides, lowers HDL cholesterol, raises blood pressure, and promotes glucose intolerance. Weight loss reduces total cholesterol, as well as its LDL and VLDL fractions, as well as triglycerides and HDL cholesterol. 18 Weight loss also improves glycemic control and lowers blood pressure.

Exercise programs that are tailored to a patient’s goals, interests, and needs are more likely to be followed. Most patients benefit from 30 minutes of aerobic exercise four or more times per week that targets large muscle groups

Shorter, but more frequent, aerobic exercise sessions provide similar benefits. Overweight patients should engage in low-intensity exercise more frequently and for longer durations

ALCOHOL INTAKE

Alcohol has a number of lipid-related effects, including increasing serum triglyceride and HDL cholesterol levels. It appears to have a negligible effect on LDL cholesterol. Excessive alcohol consumption is not recommended for the prevention of coronary heart disease because it has numerous negative consequences, including hepatic toxicity, cardiomyopathy, motor vehicle crashes, and extensive psychosocial consequences.

ANTIOXIDANTS

Oxidation and glycosylation of LDL cholesterol promote atherogenicity. 12 Antioxidant properties of several vitamins, such as vitamin C, vitamin E, and beta carotene, may protect against atherogenesis. Antioxidant vitamins are abundant in fruits and dark-green and deep-yellow vegetables.

expected outcomes

allow clinicians to optimize the management of dyslipidemia in high-risk patients, thereby further reducing the morbidity and mortality of CAD.