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.
