Elevated cholesterol affects up to 19 million Poles, only 30-40 percent. of them take treatment. The results of the NATPOL 2011 study showed that most people with elevated cholesterol are not aware of their disease.
What should the patient’s diagnostic path look like despite a pandemic? How can we adapt it to the existing conditions in the health care system?
Today we have no doubts that cholesterol is a direct cause of cardiovascular incidents, including strokes and heart attacks, which are a direct threat to the health and life of all of us. High cholesterol also contributes to the development of chronic diseases that affect an increasing part of our society. When we find that a patient has high cholesterol, it is difficult for us to indicate what consequences it will have for his health in the future. Therefore, it is very important that we start treatment as soon as possible and strive to achieve the therapeutic goal.
At the present time, in the era of the COVID-19 pandemic, the diagnosis of all chronic diseases is sometimes difficult. Some patients, fearing contact with medical staff, resign from scheduled visits, while others discontinue their current treatment. Research conducted on a group of Polish seniors, assessing their access to health care during a pandemic, indicates that up to 2/3 of respondents reported problems with access to health care. It is very important that GPs, but also cardiologists and diabetologists, who most often diagnose lipid disorders, do not forget to order their patients to undergo tests. I would like to remind you that many of our patients have changed their lifestyle over the last year. Due to remote work and lockdown, we move less and less, we reach for unhealthy snacks more often, we eat more. All these factors contribute to the formation of lipid disorders in the form of increased levels of cholesterol or triglycerides. It is also very important that the patients themselves, if they know that their lifestyle has changed, their diet is not as balanced as it was before the pandemic, ask their doctor for a referral for a lipid profile examination.
In order to optimize the path of patients requiring diagnostics towards lipid disorders and other chronic diseases, many solutions have been introduced during the pandemic to facilitate patient contact with a doctor. These are telepaths and electronic referrals as well as e-prescriptions. Therefore, the patient is not left to himself, he may receive a referral for examination during teleportation, during the next remote visit, the results of the examination are discussed with the patient and the treatment path is determined. I would also like to remind you that the laboratories that performed blood tests before the pandemic are now also functioning smoothly, so the patient is able to perform a blood test without any additional difficulties.
What tests should be performed to check blood cholesterol levels?
Access to cholesterol testing is universal. All you have to do is visit the GP surgery and ask for a referral for this test, which can also be issued to us by any other doctor. This test can also be performed as part of private healthcare, then it costs about a dozen or so zlotys. I encourage all Poles to perform a full lipid profile once a year, including those who are not under the care of any specialist, do not suffer from anything chronically and are rarely guests at the doctor’s office.
Therefore, the control of the lipid profile is a very important element of health prophylaxis. How often should a lipid profile be performed?
It all depends on what group of patients we are talking about. We have strict guidelines that tell us in which patients and how often the lipid profile should be performed. It depends on many factors, including age, family history, and comorbidities. When it comes to “healthy” people, as I mentioned before, I believe that such a test should be performed once a year.
Are there any symptoms that should worry us and prompt us to diagnose lipid disorders? And who can benefit from it?
The worst part is that high cholesterol, like high blood pressure, is a silent killer. In the case of very high blood pressure, the patient begins to experience some discomfort that may prompt him to see a specialist, and in the case of lipid disorders, even when the LDL cholesterol value is 1 mg / dl, these symptoms may not appear. They may occur in the long run, when the development of atherosclerosis continues to increase, but then it will be too late to apply preventive measures.
What is the treatment of dyslipidemia?
The first step in selecting a therapy is the assessment of cardiovascular risk. In patients with moderate, high, very high or extremely high cardiovascular risk, there is an indication for the pharmacological treatment of dyslipidaemia. In the case of a low risk, we first try to propose a lifestyle change to the patient. We encourage you to introduce a healthy, balanced diet, give up stimulants and take up physical activity. Unfortunately, only 20% of these recommendations are followed. patients, others – very often healthy and very active people – are not able to accept the new lifestyle. Then doctors have no choice but to use natural products with proven effectiveness in lowering cholesterol levels, such as dietary supplements based on red fermented rice, containing monacolin K, barberine or bergamot are also effective. They are also a good therapeutic option for patients with the so-called statinophobia or in people with statin intolerance. In the remaining patients, statins are the most frequently used form of therapy. For many years, they have been the gold standard in lowering LDL cholesterol as well as other lipid fractions. Statins are pleiotropic, have anti-inflammatory, antioxidant, anticoagulant, antiplatelet and many other effects. If statin treatment turns out to be ineffective, we add new medications to the therapy and use combination therapy. There is also a certain group of patients in whom statin-based therapy may not be effective due to an increase in triglyceride levels, most often obesity, atherogenic dyslipidaemia, type II diabetes, high triglyceride levels and high blood levels. non-HDL cholesterol, in such patients, the use of fibrates has proven to be a very effective therapeutic option for years; Omega-3 polyunsaturated acids are also used here.
Recently, patients have often thought that their disease would “wait for the pandemic to end”. They canceled visits to specialists and discontinued treatment. How important is continuity in treatment with hypercholesterolaemia?
Continuity of therapy in this condition is extremely important. Patients, and often physicians themselves, have the impression that when a patient achieves a therapeutic goal, treatment may be discontinued. Our experience and the results of many studies show, however, that such a procedure is incorrect, and leaving the patient without appropriate therapy, even for several months, causes a re-increase in the level of cholesterol and other lipid parameters. This can ultimately result in the existing atherosclerotic plaque becoming unstable, which can lead to a heart attack, stroke or death.
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