Cholesterol recommendations and control

Cholesterol recommendations and control

All patients with cardiovascular diseases (CVD) should be screened to determine the level of cholesterol in serum. Some controversy remains regarding screening for primary prevention. The NCEP recommends routine screening for all individuals> 20 years old, ACP (American College of Physicians) – only men 35–65 years old and women 45–65 years old, and USPSTF – screening all men aged> 35 years old and women aged 45 years old. Screening for CVD patients should include a complete fasting lipid profile, including total cholesterol, cholesterol, and HD. For patients without CVDs, the need for screening for HDL cholesterol is questionable: the NCEP recommends such screening, but the ACP does not.

Due to the fact that cholesterol cholesterol levels and the ratio of cholesterol to cholesterol cholesterol are very strong predictors of risk and help in identifying individuals with elevated levels of LDL cholesterol, despite moderate levels of cholesterol, it seems appropriate to determine cholesterol cholesterol simultaneously with cholesterol. .

To reduce the prevalence of HLP in the United States, the NCEP in 1988 released the first report on the treatment of HCS in adults. The latter was published in 2002, in 2004 some components were updated. According to the latest NCEP guidelines, the number of adults in the United States who need to modify lipid levels through lifestyle changes has grown from 52 million to 65 million, and those who need medication from 13 million to 36 million. The goals of the intervention are determined based on the individual risk of coronary heart disease. (KBS).

The updated ATP III guideline recommends different therapeutic goals depending on the patient’s overall risk calculated on the Framingham scale, taking into account other risk markers (elevated levels of TG, CRP and family history). Patients with an existing ASC (or its equivalent – DM or PAD) are at the highest risk of a cardiovascular event (SSSob), therefore their target level of ANS cholesterol is the lowest – <100 mg / dL or even lower – <70 mg / dl for those who have recently had ACS or have KBS and diabetes or high or poorly controlled RF.

In 2006, the ACC / ANA updated their secondary prevention guidelines on lipid control, repeating the recommendations made by the NCEP and strengthening some of them. As with the NCEP guideline, a target LDL-C level of <70 mg / dL was added as optional. However, ACC / ANA expanded the choice of target LDL cholesterol levels <70 mg / dl for all patients with CHD, and not just those who have a very high risk; However, this position is not supported by all researchers. In addition, patients with a TG level of 200-499 mg / dL should have a non-HDL cholesterol content <130 mg / dL, and further decrease to <100 mg / dL is considered appropriate.

According to the NCEP primary prevention guidelines, patients with a moderately high risk of CHD (RF> 2, total 10-year risk 10-20%) should receive appropriate therapy to achieve LDL <130 mg / dL (optimally <100 mg / dL) . These indicators are also a goal for patients with moderate risk (RF> 2, 10-year risk <10%). For patients with a lower risk, the target LDL level should be <160 mg / dL. In addition to this, according to the recommendations of the NCEP on lifestyle changes, the diet should include 25-35% of calories due to fat, while the proportion of saturated fatty acids should be <7% and cholesterol <200 mg / day.

It is difficult for patients to understand the calculation of calories in percentages, so it is recommended to convert them to grams of fat, protein and other components of the diet. Professional nutrition counseling can also be helpful. If using dietary therapy fails to reach the target level of LDL cholesterol, it is necessary to begin drug therapy. In all cases, it should be an addition to diet therapy and increase of FA.

The guidelines of the European Society Cardiology also include gradations of target levels. Although they are identical for all patients (cholesterol <190 mg / dl, or 5 mmol / l; LDL cholesterol <115 mg / dl, or 3 mmol / l), the duration and intensity of drug therapy are different. In primary prevention, if the 10-year absolute risk of CHD or a risk calculated for the age of 60 years> 5%, modification of the lifestyle and analysis of lipid levels after 3 months are recommended. If after this time, cholesterol or LDL cholesterol is still above the target level, then you can begin drug therapy.

For asymptomatic high-risk patients who have cholesterol and LDL cholesterol are close to target levels (5 and 3 mmol / l, respectively), target levels should be <4.5 mmol / l (175 mg / dl) for cholesterol and <2, 5 mmol / l (100 mg / dl) for LDL cholesterol. The same target levels are set for persons with KBS and / or SD.

In secondary prophylaxis in patients with high LDL cholesterol and low HDL cholesterol or high TG, aggressive treatment is necessary, perhaps even combined. For individuals with established disease, low levels of HDL cholesterol and normal LDL cholesterol, pharmacological intervention may be considered based on the results of the VA-HIT study.

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