Dyslipidemias are a cardiovascular risk factor. Their management by hygieno-dietetic measures supplemented if necessary by drug treatment is therefore very important to prevent myocardial infarctions and strokes. 

Definition

Dyslidemias result from abnormalities in the distribution of lipids (abnormalities in lipid levels) in the blood. Lipids are a set of various molecules such as free fatty acids, cholesterol, triglycerides, phospholipidids. 

Dyslipidemias can be classified into several groups:

• pure hypercholesterolemia (elevated LDL-cholesterol (“bad” cholesterol) levels,
• pure hypertriglyceridemia: high triglyceride level
• mixed hypertriglyceridemia: high LDL-cholesterol and triglyceride levels,
• low HDL-cholesterol (good cholesterol). 

Cholesterol-related abnormalities are the most common. 

Causes 

Dyslipidemias can have primary causes (genetic) and secondary causes (sedentary lifestyle and a diet too rich in saturated fat, cholesterol and trans fatty acids, diabetes, hypothyroidism, heavy alcohol consumption, etc.)

The most common cause of dyslipidemia results from the interaction of genetic factors (familial dyslipidemias) and environmental factors. 

Diagnostic 

A complete lipid assessment (carried out with a blood test on an empty stomach) makes it possible to make a diagnosis of dyslipidemia. It includes a determination of triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol.

In adults, cholesterol is considered normal if total cholesterol is less than 2,20 grams per liter of blood (m / l), if LDL cholesterol is less than or equal to 1,60 g / l, and if HDL cholesterol is greater than 0,40 g / l. 

The normal level of triglycerides is between 1,5 g and 2 g / l. We then speak of hypertriglyceridemia when the triglyceride level is between 4 and 5 g / l. 

Persons concerned 

Pure hypercholesterolemia is the anomaly most often encountered: 30% of the French adult population is affected. 12% of adults in France have a low HDL-cholesterol level.

Risk factors 

Dyslipidemias have a genetic factor. Genetic mutations are at the origin of an abnormality in the distribution of lipids. 

The most common secondary risk factor is a diet too rich in “bad” fats and a sedentary lifestyle. The other risk factors are diabetes mellitus, a thyroid disorder …

Dyslipidemias do not give symptoms or only symptoms in the event of a very high cholesterol level (presence of xanthomas, deposits of cholesterol plaques visible to the naked eye on the skin, eyes, tendons). Dyslipidemias are silent (they are often called silent killers). This is why regular screening is essential. 

The symptoms of dyslipidemia are those of cardiovascular complications. Too high a total cholesterol level, an increase in LDL-cholesterol, a drop in LDL-cholesterol and, to a lesser extent, hypertriglyceridemia, are factors of atherosclerosis, responsible for cardiovascular accidents: coronary disease ( angina pectoris and myocardial infarction), cerebrovascular accident, obliterating arterial disease of the lower limbs). 

Treatment should be appropriate for dyslipidemia. High cholesterol and hypertriglyceremia are not treated the same way. A cardiovascular risk assessment is performed. It allows a comprehensive care of the person who has dyslipidemia.

However, dietary and lifestyle changes represent an essential part of the care. 

Management of hypercholesterolemia 

For people with low to moderate cardiovascular risk, the initial treatment is a diet low in saturated fat combined with regular physical activity. If after 3 months, the LDL-cholesterol level has not fallen enough, cholesterol-lowering treatment (most often a statin) is prescribed. 

For people with a high cardiovascular risk, a cholesterol-lowering drug is prescribed from the outset in addition to the hygieno-dietetic measures. 

Management of hypertriglyceridemia

The hygiene and dietetic measures are the basis of the treatment. Drug treatment is based on fibrates in isolated hypertriglyceridemia. When associated with hypercholesterolemia, it is rather a statin that is prescribed. 

Natural treatment of dyslipidemia: beware of red yeast rice

The HAS recalled in the management strategies for dyslipidemia (2017) that “food supplements based on red yeast rice (containing monacolin K, also called lovastatin) expose to adverse events similar to those of other statins . These supplements are not an alternative to drugs used for the treatment of excess cholesterol, and should not be used in combination with a statin or as a replacement for a statin, as their effectiveness is low. “

Maintaining a healthy weight, eating a balanced diet with a diet low in saturated fat, and being active are preventive measures for dyslipidemia. 

A lipid assessment is recommended in men over 40, in women over 50 or if they are postmenopausal or before taking hormonal contraception. 

An exploration of lipid function is recommended regardless of age in case of: 

• cardiological disease, proven cardiovascular disease;
• arterial hypertension;
• diabetes;
• smoking now or stopped for less than three years;
• BMI ≥ 30 mg / kg2 or waist circumference> 94 cm in men (> 90 for Asians),> 80 cm in women
• autoimmune disease or chronic inflammatory disease;
• moderate to severe chronic renal failure;
• family history of early cardiovascular disease: myocardial infarction or sudden death before age 55 in the father or in a first degree male relative,
• myocardial infarction or sudden death before age 65 in the mother or in a first degree female relative
• family history of dyslipidemia.