treatment

How to Treat Ischaemic Heart Disease Atherosclerosis?


Things to note:
Lifestyle modification
All persons with risk factors for ischaemic heart disease should be encouraged to make the following lifestyle changes as appropriate:
  • Smoking cessation.
  • Weight reduction in the overweight patients, i.e. BMI > 25 kg/m2.
  • Maintain ideal weight, i.e. BMI < 25 kg/m2.
  • Reduce alcohol intake to no more than 2 standard drinks/day
  • Follow a prudent eating plan i.e. low saturated fat, high fibre and unrefined carbohydrates, with adequate fresh fruit and vegetables.
  • Moderate aerobic exercise, e.g. 30 minutes brisk walking at least 3 times a week.

Medical Treatment::
Indication for lipid lowering drug therapy
  • Established atherosclerotic disease, irrespective of cholesterol or triglyceride plasma concentrations:
    • Ischaemic heart disease,
    • Peripheral vascular disease, or
    • Atherothrombotic stroke.
  • Type 2 diabetics > 40 years of age.
  • Chronic kidney disease (eGFR < 60 mL/minute.)
  • A risk of MI of greater than 20% in 10 years (see table above).
Such high-risk patients will benefit from lipid lowering (statin) therapy irrespective of their baseline LDL-C levels.
  • HMGCoA reductase inhibitors (statins) that lower LDL by at least 25%, e.g:
    • Simvastatin, oral, 10 mg at night.
Note:
  • This is always in conjunction with ongoing lifestyle modifications when lipid - lowering drugs are used.


When to refer:
  • Random cholesterol >7.5 mmol/L.
  • Fasting (14 hours) triglycerides >10 mmol/L.

treatment