Treatment goals for dyslipidemia

The article was professionally consulted by Specialist Doctor II Nguyen Quoc Viet - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital. The doctor has more than 20 years of experience in the examination and treatment of cardiovascular diseases and Interventional Cardiology.

Dyslipidemia is a condition in which plasma cholesterol and triglycerides (TG) are elevated, or both, or HDL-C (high-molecular-weight) or LDL-C (high-molecular-weight) concentrations. low), increases the process of atherosclerosis.

Cholesterol
Normal: < 5.2 mmol/l (< 200 mg/dl) Limit raised: 5.2 - 6.2 mmol/l (200 - 239 mg/dl) Hypercholesterolemia: > 6.2 mmol/ l (>240 mg/dl) Triglyceride
Normal: <1.7 mmol/l (<150 mg/dl). Increase limit: from 1.7 to 2.25 mmol/l (150-199 mg/dl). Increased Triglyceride: from 2.26 to 5.64mmol/l (200 - 499mg/dl). Very elevated: > 5.65 mmol/l (> 500 mg/dl). HDL-C (vascular-protective Lipoprotein), low HDL-C is associated with high risk of atherosclerosis
Normal: > 0.9 mmol/l. When HDL-C <0.9 mmol/l (<35mg/dl) is decreased. LDL–C (Lipoprotein promotes atherogenesis)
Normal: <3.4 mmol/l (<130 mg/dl) Limit raised: 3.4 to 4.1 mmol/l (130-159 mg /dl) Much increased: > 4.1 mmol/l (>160 mg/dl) Mixed dyslipidemia
Mixed dyslipidemia is when Cholesterol > 6.2 mmol/l and Triglycerid between 2.26 – 4.5mmol/l.

2.1 Very High Risk Subjects with any of the following:
Clinically or clearly established cardiovascular disease. Clinically confirmed heart disease: history of myocardial infarction, acute coronary syndrome, coronary revascularization (PCI, CABG) and other revascularization procedures, stroke, transient ischemic attack peripheral artery disease. Cardiac disease is clearly identified on imaging as a condition that strongly promotes significant events such as atherosclerotic plaque on coronary angiography or carotid echocardiography. Diabetes with target organ damage (proteinuria) or another major risk factor such as smoking, hypertension, or dyslipidemia. Severe chronic kidney disease (GFR <30 mL/min/1.73 m2) SCORE score ≥ 10% (10-year cardiovascular mortality risk). 2.2 High risk Subjects with:
A significantly increased risk factor, particularly cholesterol > 8mmol/L (>310 mg/dL) (such as familial hypercholesterolemia) or blood pressure ≥ 180/110 mmHg . Most patients with diabetes (some young patients with type 1 diabetes may be at low or moderate risk). Moderate CKD (GFR 30-59 mL/min/1.73 m2) SCORE scores ≥ 5% and < 10% for 10-year risk of fatal cardiovascular disease.

2.3 Mean risk SCORE scores ≥ 1% and < 5% for 10-year risk of fatal cardiovascular disease.
2.4 Low risk SCORE score < 1% for 10-year risk of fatal cardiovascular disease.

Treatment goals for dyslipidemia should be:
Smoking: No exposure to tobacco of any kind
Diet: A low-saturated fat diet that focuses on whole grain products, vegetables, fruits and fish.
Physical activity: Get 2.5 - 5 hours of moderate-vigorous physical activity each week or 30 - 60 minutes a day. Body weight: BMI 20-25 kg/m2, waist circumference < 94cm (men) and < 80cm (women). Blood pressure: Blood pressure < 140/90 mmHg. Diabetes: HbA1c: <7% (<53 mmol/mol) Target Lipid: LDL-C is the primary goal of dyslipidemia treatment:

In patients at very high cardiovascular risk: LDL-C goal <1.8 mmol/L (70 mg/dL) or at least 50% reduction if baseline 1.8-3.5 mmol/L (70 and 135 mg/dL). In patients at high cardiovascular risk: LDL-C goal <2.6 mmol/L (100 mg/dL) or at least 50% reduction if baseline value 2.6-5.2 mmol /L (100 and 200 mg/dL).
+ For people at low or moderate risk: LDL-C goal <3.0 mmol/L (115 mg/dL)
+ Secondary non-HDL-C goal is <2.6 mmol /L; 3.4 mmol/L and 3.8 mmol/L (100, 130 and 145 mg/dL) respectively for those at very high, high, and moderate risk.
+ HDL-C: no target, but elevations >1.0 mmol/L (40 mg/dL) in men and >1.2 mmol/L (48 mg/dL) in women suggest cardiac risk lower circuit.
+ Triglycerides: no target but <1.7 mmol/L (150 mg/dL) indicates lower risk and higher levels indicate need to look for other risk factors.