Contents
Medical treatments for hyperlipidemia (Cholesterol and triglycerides)
The treatment varies according to the values of the lipid profile and the presence or not of other risk factors for heart disease.
Medical treatments for hyperlipidemia (cholesterol and triglycerides): understand everything in 2 min
For people whose health check shows a high risk of coronary heart disease, a significant change in life habits occupies the central place of the therapeutic approach : diet, smoking, physical activity, alcohol consumption.
If possible, use the services of a nutritionist doctor or a dietician. It is recommended that you see your family doctor again 4 to 6 weeks after the first visit.
According to the most recent data, the pharmacological treatment would have an interesting effectiveness mainly for people who have already had a heart attack or an angina attack, to prevent the occurrence of other heart problems.
Diet
Food recommendations For some practical advice, consult our special diet Hypercholesterolemia and Diet Portfolio. |
Here are dietary recommendations :
- Restricttotal calorie intake in order to achieve and maintain a weight stable without food restriction : this is the most important goal to achieve. Calculate your body mass index or BMI (which ideally should be between 18,5 and 25 for Westerners);
- Have a diet low in salt and refined sugars (sugary drinks, desserts and other sweets);
- Replace saturated fats and trans fats with unsaturated fats. Must therefore avoid animal fats (butter, shortening, fatty meats, etc.);
- Eat fatty fish like mackerel, salmon, sardines 2 to 3 times a week (sources of omega-3);
- Increase the consumption of seasonal fruits and vegetables;
- Increase the consumption of dried fruits such as nuts and almonds and dried vegetables such as chickpeas, broad beans, beans;
- Increase the consumption of spices, aromatic herbs, garlic, onions, lemon juice;
- Give preference to unrefined cereals;
- Consume the oil moderately and choose instead olive oil (monounsaturated fatty acid), rapeseed or flaxseed (polyunsaturated fatty acids such as omega 3)
- Eat few dairy products;
- Consumealcohol moderately. In some cases, total abstention is recommended.
As a first step, some doctors recommend removing the desserts (other than fruit), which are unnecessary sugars and evaluate the effect after a few months. It is also important to monitor the amount of pain consumes.
Let us also mention the portfolio diet, a diet designed to improve the lipid profile, which is akin to vegetarianism. Followed rigorously, this diet would lower LDL cholesterol levels by up to 35%6,7. To find out more, see the advice of nutritionist Hélène Baribeau: Hypercholesterolemia and diet Portfolio.
The benefits of the Mediterranean diet on heart health are now widely recognized. (the recent PREDIMED study confirms the benefits).
An expert’s point of view
Dr Martin Juneau, cardiologist Director of Prevention at the Montreal Heart Institute
Does a person who decides to change their eating habits get results quickly on their cardiovascular health? It may come as a surprise, but the results are visible the same day. You eat, for example, a junk food meal. In the hours that follow, we can measure the direct impact on the ability of your arteries to dilate. This is called in scientific terms endothelial function. This is the first condition, before atherosclerosis [plaque formation in the arteries]. If, on the other hand, you say to yourself, “well, today I have had enough of junk food, I’m going to cook myself a piece of salmon with a salad, olive oil and tomatoes”, the exact opposite will happen: your endothelial function will improve. There is therefore an immediate effect on the blood and also on the vessels. Obviously, as this positive effect repeats itself every day, the health of the arteries eventually improves after a while. But there is also an immediate effect. As with smokers who quit smoking: within 24 hours the level of carbon monoxide in their blood drops dramatically, and within days you see effects on blood platelets, clotting, etc. |
Physical exercise
The benefits ofphysical activity on health are manifold. In addition to helping with weight loss and weight maintenance, being active has been shown to increase HDL levels and lower triglycerides.
Effective! A person who becomes active can expect to raise their HDL (good cholesterol) level by 5% to 6%50. By losing 5 kg, his HDL level rises by 10%. These 2 effects are cumulative. |
A minimum of 30 minutes of moderate to vigorous activity per day (for example, walking). Ideally, you should aim for an expenditure of 1 calories per week. For example, one person could choose to walk for 000 minutes each day, another to walk for 30 hour 1 times a week, etc.
Consult our file Being active: the new way of life. See also our Fitness series.
pharmaceuticals
The pharmaceuticals, obtained on prescription from a doctor, are mainly used to lower LDL (“bad cholesterol”) and total cholesterol levels. It is more rarely used to lower triglyceride levels, which respond very well to improving blood life habits. Research is underway to develop approaches that promote an increase in HDL (“good cholesterol”) levels.
There are 5 families :
- the statins, which lower the level of LDL, but without effect on the level of HDL (for example, atorvastatin or Lipitor® and simvastatin or Zocor®);
- the resins (like cholestyramine), which bind to bile salts and cause the liver to use more cholesterol from the bloodstream;
- un intestinal cholesterol absorption inhibitor, which causes the body to absorb less cholesterol from food (ezetimibe);
- the fibrates, which reduce triglyceride levels (eg fenofibrate and gemfibrozil);
- la niacin or nicotinic acid, which increases HDL cholesterol levels and lowers triglyceride levels – doctors rarely use it.
The statins are the most frequently prescribed drugs. Generally well tolerated, they can nevertheless cause various side effects. This would be the case for about 5% of people who take it. Some of the most important are cramp-like muscle pain that can lead to rhabomyolysis.
The effectiveness of statins in primary prevention (in people who have never had a cardiovascular accident) is however controversial. In 2007, the French cardiologist Michel de Lorgeril spoke out against the use of statins in a book intended for the general public.49. Professor Even has also largely fueled the media debate and sparked a lively controversy on the part of the cardiologists concerned. In June 2010, the publication of new scientific data rekindled the debate. The ability of these drugs to prevent an angina attack or heart attack in patients at risk is reportedly very low or non-existent.48,51. Read our news: Statins: no impact on the prevention of mortality.
The experts’ point of view
Dr Martin Juneau, cardiologist Director of Prevention at the Montreal Heart Institute There is still controversy over the effectiveness of statins. When do you think statins are useful? For patients who have had angina or a heart attack, or who have documented coronary artery disease, I believe there is no doubt: the studies clearly confirm the effectiveness of statins. However, for people who have never had an angina attack or a heart attack, the effectiveness in preventing a first cardiac event is very low or questionable, but it depends on the case. The typical patient to whom I will give a statin for prevention (called primary) is a man or a woman in his fifties or sixties who has hereditary risk factors and who is already making all the desirable efforts in terms of ‘diet, smoking, etc. And when I tell people to change their lifestyle, that’s not an optional recommendation. I am very serious about this. I say this because every day people tell me, “Since taking my statin, my doctor tells me my cholesterol is perfect, so I started eating anything again. Patients who do this are wasting their money and the government’s money. I think the statin alone does not protect people from the effects of poor lifestyle habits. The point of view of Dr Cocaul, nutritionist Paris One of the reports from the National Health Insurance Fund (CNAM) estimated that a majority of people treated for excess cholesterol (2/3) should not have been treated while other people, at high cardiovascular risk, were not receiving any treatment. Doctors must therefore consider the relevance of their prescriptions and assess the benefit / risk ratio that they provide to their patients. And ask each time: is there legitimacy to deal with? If you have excess cholesterol and are in doubt about your treatment, do not hesitate to seek a second opinion from a cardiologist, endocrinologist or nutritionist. The cost incurred is not the only parameter to be taken into account but the service provided to each person who consults. It is therefore essential that the doctor listen to everyone, take the time to weigh the pros and cons before initiating treatment, and remember that many people no longer take their treatment correctly if they have too much medication to take. We will constantly recall the antiphon of Hippocrates “let food be your first medicine”.
|