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                Management Dyslipidemia

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[Up] [Types of lipids] [Dyslipidemia] [Causes Dyslipidemia] [Complications Dyslipidemia] [Management Dyslipidemia] [Life style modification] [Free radicals] [Homocysteine role] [Food in dyslipidemia] [Cholesterol levels] [Risks for heart attacks] [Investigations]

 

Management Dyslipidemia

 

 

    

                                                                                                            

    

        Clinical Examination                                    Investigations                               Medicine to lower lipids

 

                                                                                            

      

         Patient Education                      Regular Blood pressure monitoring                        Regular Exercise

 

 

                                                                                             

   

       Life Style Modifications                                                                                           Healthy Diet

    

  Clinical Examination

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To detect clinically the complications of, and associated illnesses with Dyslipidaemia like Hypertension, Neurological deficit, Lipid deposits under skin, Cardiac status, Arterial pulsations and hardening.

 

   Investigations

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Appropriate investigations to detect complications of, and associated illnesses with Dyslipidaemia like Diabetes, Angina, Lipid abnormalities, End organ damage due to Atherosclerosis, Hypertension, associated risk factors.

  

Medicine to lower lipids

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Lipid abnormalities require long term treatment with appropriate medicines which lower bad lipids (cholesterols) and raise good lipid (cholesterol). This prevents, reverses and reduces the chances of further arterial damage due to Dyslipidaemia and thus decreases ongoing risk of heart attacks, stroke, Hypertension etc.

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Blood thinning medicines (Aspirin in low doses) and certain vitamins in high doses -Antioxidants, are also required.

  

Role of Exercise, Diet and Life Style Modifications 

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Healthy balanced low fat low salt diet rich in antioxidants will help in dramatically improving abnormal lipid ratios and also decrease the requirement of lipid lowering drugs.

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Exercise done regularly has a favorable effect on lipid profile and also helps to increase good cholesterol-HDL naturally. It prevents and removes deposits inside blood vessels. In long run it lowers Blood pressure, makes the heart strong, reduces weight, helps better control of diabetes.

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Life style modifications include besides healthy eating and regular exercise, - avoiding alcohol, smoking and relaxation activities. Controlling these risk factors are equally important for favorable long term results.

  

 

Treating high cholesterol.

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The main goal of cholesterol lowering treatment is to lower your LDL levels enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower LDL goal will be. To find your LDL goal, find out your risk category.

 

 

There are two main ways to lower your cholesterol.

 

Therapeutic life style changes (TLC)

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Includes a Cholesterol- lowering diet (called a TLC diet), Physical activity and Weight management. TLC is for every one whose LDL is above goal.

 

Drug treatment.

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If cholesterol lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

 

If you are in Category

LDL Goal (mg/dl)

                   If your LDL is (mg/dl)

 below 100

 100 or  >

    100-129

    > 130

                    >160

Category 1

Highest risk

   < 100

 TLC diet

 desirable

 TLC diet

 is must

  TLC diet

  +Drugs

           TLC diet

            +Drugs

 

Category 2

Next Highest risk

   < 130

 

 

 

           TLC diet

            +Drugs

  (if no response in 3 mo)

 

Category 3

 Moderate risk

   < 130

 

 

 

          TLC diet

      TLC diet  +Drugs   

  (if no response in 3 mo)

Category 4

Low/Moderate risk

   < 160

 

 

 

 

      TLC diet  +Drugs

  (if no response in 3 mo)

    or if LDL is 190 or >

 

 

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To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.

 

 

Lowering cholesterol with Therapeutic Lifestyle Changes (TLC)

TLC is a set of things you can do to help lower your LDL cholesterol.

 

The main parts of TLC are:

 

The TLC Diet.

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This is low saturated fat, low cholesterol eating plan that calls for less than 7 % of calories from saturated fats and less than 200 mg of dietary cholesterol per day.

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The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain.

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If your LDL is not lowered enough by reducing saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant steroids (for example, cholesterol-lowering margarines and salad dressings) can also be added to the TLC diet to boost its LDL- lowering power.

 

Weight management

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Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that include high triglyceride and/or low HDL levels and being over-weight with a large waist measurement (more than 40 inches for men and more than 35 inches for women.)

 

Physical activity

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Regular physical activity (30 minutes on most, if not all days) is recommended for every one.

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It can help raise HDL and lower LDL and is especially important for those with high triglyceride and /or low HDL levels who are overweight with a large waist measurement.

       

Drug treatment

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Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with life style changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well.

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There are several types of drugs available for cholesterol lowering including statins, bile acid sequestrants , nicotinic acid and fiber acids. Your doctor can help decide which type of drug is best for you.

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The statin drugs are very effective in lowering LDL levels and are safe for most people.

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 Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs.

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Nicotinic acid lowers LDL and triglycerides and raise HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglycerides and low HDL levels.

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Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and /or low HDL level, if present.

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The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.

   

Starting to Exercise for a Healthy Heart

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If you are recovering from heart surgery or a heart attack, your doctor has probably prescribed a daily graduated walking program to help your recovery. This program is also good if you have not exercised in a long time, and your doctor recommends walking to help control your blood pressure or reduce your chances of cardiovascular disease.

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Daily exercise may be one of the best gifts you can give yourself. It improves circulation, lowers blood pressure, helps in a weight control program, and strengthens your muscles. It can also help you sleep better, feel more energetic, and increase your sense of well-being.

   

      

General guidelines

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If you are recovering from heart surgery or a heart attack, have someone with you for the first several weeks.

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Wait at least 2 hours after eating.

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Wear comfortable rubber-soled walking shoes and loose clothing.

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Avoid extreme heat or cold. Don't exercise if the temperature is over 85o F (particularly if the humidity is over 75%) or under  20o F. During bad weather, walk in a covered shopping mall or gym.

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Always begin with a 5-minute warm-up of stretching and slow walking.

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Adopt a steady, rhythmic pace and keep it up. If you have attacks of leg cramps (claudication), you may need to alternate walking with rest periods.

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Watch for signs of overexertion. Stop walking if any of these symptoms occurs: chest pain (angina), palpitations, irregular heartbeat, dizziness or lightheadedness, shortness of breath for more than 10 minutes, nausea or vomiting, extreme fatigue, pale or splotchy skin, or "cold sweat." Call your doctor if these symptoms persist.

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Cool down with light activity for 5 minutes; for example, if you are walking fast, slow down to a stroll.

  

 

Graduated walking program

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Graduated walking programs are designed to slowly increase the time, distance, and walking pace. Because they begin very slowly, you may be tempted to skip ahead if you feel the schedule is "too easy." Don't.

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The graduated schedule allows your heart time to adjust to increasing amounts of work. Skipping ahead may overwork your heart. Carry out the program just as your doctor orders. If you develop symptoms of overexertion, return to the previous week's schedule until you are ready to progress.

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You must know the exact distance to determine how fast you should walk. You can measure the distance on your car odometer. If you find you walk the distance in less time than the schedule specifies, slow your pace down next time. If it takes longer, you need to walk a little faster.

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As soon as you stop walking, take your pulse. Your heart rate should not exceed the upper limit of the target heart rate set by your doctor. For many people, this is less than 115 beats per minute.

 

   FIRST 9 WEEKS

Week Walking    Time / Distance

1                       5 minutes 1/4 mile

2                       5 minutes 1/4 mile

3                     10 minutes 1/2 mile

4                     10 minutes 1/2 mile

5                     15 minutes 3/4 mile

6                     15 minutes 3/4 mile

7                     20 minutes1 mile

8                     20 minutes1 1/2 miles   

9                     30 minutes2 miles

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At this point, you are ready to extend your walking time. Because the exercise will be sustained for a longer time, your pace will need to be a little slower the first few weeks. By week 12, your walking speed will increase to a brisk walk.

    

WEEKS 10 to 12

Week Walking       Time Distance

    10                           40 minutes2 miles

    11                           40 minutes2 miles

    12                           60 minutes3 miles

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You must continue with an exercise program after week 12. You should continue your walking program, join a medically supervised walk-jog program, or add another form of exercise to your program such as bicycling. Follow your doctor's advice about the best program for you.

 

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