medigraphic.com
ISSN 0188-9796 (Print)

2004, Number 1

<< Back Next >>

Rev Endocrinol Nutr 2004; 12 (1)

Diagnosis and treatment of dyslipidemias: Position of the Sociedad Mexicana de Nutrición y Endocrinología

Aguilar SCA, Gómez PFJ, Lerman GI, Cuauhtémoc Vázquez Chávez, Óscar Pérez Méndez, Carlos Posadas Romero

Language: Spanish
References: 54
Page: 7-41
PDF size: 289.90 Kb.


ABSTRACT

This document supported by the Sociedad Mexicana de Nutrición y Endocrinología presents the recommendations for the diagnosis and treatment of dyslipidemias based on the experience of a group of Mexican experts. The information is presented in a comprehensive manner, using flow charts designed for helping clinicians in the diagnosis and treatment of these disorders. The recommendations are adapted for the epidemiology of dyslipidemias in Mexico; they are based in clinical and randomized controlled trials. The main conclusions are: 1) the search for affected cases is cost-effective in any adult older than age 20, 2) the diagnostic approach begins classifying cases by syndromes (isolated hypercholesterolemia, isolated hypertriglyceridemia, mixed hyperlipidemia and hypoalphalipoproteinemia), 3) the etiology of the lipid abnormality can be identified in a large percentage of the cases, 4) the identification of the cause is helpful for the estimation of the cardiovascular risk, 5) the systematic use of the Framingham tables is not recommended, 6) several conditions are identified as “high priorities” for receiving lipid-lowering therapy; cases with these conditions are considered as candidates for drug therapy, 7) the treatment of conditions not considered as “high priorities” should be based on life style modifications, 8) specific treatment goals are proposed for high priority cases; stratified LDL cholesterol goals are not recommended here, 9) statins are the first choice for cases with isolated hypercholesterolemia; fibrates are the first choice for isolated hypertriglyceridemia. In conclusion, the treatment of plasma lipid abnormalities is a critical component of any cardiovascular prevention program; in order to achieve that goal, each risk factor should be diagnosed and treated properly.


REFERENCES

  1. Ira Tabas. Cholesterol in health and disease. J Clin Invest 2002; 110: 583-590.

  2. Law MR. Lowering heart disease risk with cholesterol reduction: evidence from observational studies and clinical trials. Eur Heart J Suppl 1999; (Suppl 1): S3-S8.

  3. Posadas-Romero C, Tapia-Conyer R, Lerman-Garber I et al. Cholesterol levels and prevalence of hypercholesterolemia in a Mexican adult population. Atherosclerosis 1995; 118: 275-284.

  4. Aguilar-Salinas CA, Olaiz G, Valles V, Ríos JM, Gómez PFJ, Rull JA, Rojas R, Franco A, Sepúlveda J. High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nation wide survey. J Lipid Research 2001; 42: 1298-1307.

  5. Lerman-Garber I, Rull Rodrigo JA. Epidemiology of diabetes in Mexico and associated coronary risk factors. Isr Med Assoc J 2001; 3: 369-373.

  6. Perez-Mendez O, Luc G, Posadas-Romero C. Low concentrations of high-density lipoproteins (HDL) in plasma and coronary artery disease. Arch Inst Cardiol Mex 2000; 70: 312-321.

  7. Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Together with members of the Task Force. Prevention of coronary heart disease in clinical practice: Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis 1998; 140: 199-270.

  8. Expert panel on detection, evaluation and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation and treatment of high cholesterol. JAMA 2001; 285: 2486-2497.

  9. International Atherosclerosis Society. Harmonized clinical guidelines on prevention of atherosclerotic vascular disease 2003.

  10. American College of Physicians. Guidelines for using serum cholesterol, high density lipoprotein cholesterol and triglyceride levels as screening test for preventing coronary heart disease in adults. Ann Intern Med 1996; 124: 514-517.

  11. Pyörälä K, De Backer G, Graham I, Poole-Wilson P, Wood D. On behalf of the Task Force. Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Atherosclerosis 1994; 110: 121-161.

  12. De Backer G, Ambrosioni E, Barch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice, Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003; 24: 1601-1610.

  13. American Academy of Pediatrics. Cholesterol in Childhood. Pediatrics 1998; 101: 141-149.

  14. Barter PJ, Brewer B, Chapman J et al. Cholesteryl Ester Transfer Protein: A Novel Target for Raising HDL and Inhibiting Atherosclerosis. Arterioscler Thromb Vasc Biol 2003; 23: 160-167.

  15. Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 1998; 81: 7B-12B.

  16. Despres JP, Lemieux I, Dagenais GR et al. HDL-cholesterol as a marker of coronary heart disease risk: the Quebec cardiovascular study. Atherosclerosis. 2000; 153: 263-272.

  17. Lloyd-Jones D, Wilson P, Larson M et al. Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Arch Intern Med 2003; 163: 1966-1972.

  18. Anderson KM, Castelli W, Levy D. Cholesterol and mortality: 30 years of follow-up from the Framingham Study. JAMA 1987; 257: 2176-2180.

  19. Friedewald WT, Levy IR, Fredrickson DS. Estimation of the concentration of low density lipoproteins cholesterol in plasma without the use of the ultracentrifuge. Clin Chem 1972; 18: 449-502.

  20. Rubies-Prat J, Reverter JL, Senti M et al. Calculated low-density lipoprotein cholesterol should not be used for management of lipoprotein abnormalities in patients with diabetes mellitus. Diabetes Care 1993; 16: 1081-1086.

  21. Aguilar-Salinas CA, Delgado A, Gómez-Pérez FJ. The advantages of using non-HDL cholesterol in the diagnosis and treatment of dyslipidemias (letter). Arch Intern Med 2002; 162: 102-106.

  22. Walldius G, Jungner I, Holme I et al. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 2001; 358: 2026-2033.

  23. Sanchez-Castillo C, Velázquez-Monroy O, Berber A et al. Anthropometric cutoff points for predicting chronic diseases in the Mexican National Health Survey 2000. Obes Res 2003; 11: 442-451.

  24. Hernández OA, Monter G, Zamora J et al. Association of visceral fat with coronary risk factors in a population-based sample of postmenopausal women. In J Obesity 2002; 26: 33-39.

  25. Durrington P. Dyslipidemia. Lancet 2003; 362: 717-731.

  26. Aguilar-Salinas CA. Hipercolesterolemia familiar. Revista de Investigación Clínica 2001; 53: 254-265.

  27. Scientific Steering Committee on behalf of the Simon Broome Register Group. Mortality in treated heterozygous familial hypercholesterolemia: implications for clinical management. Atherosclerosis 1999; 142: 105-112.

  28. Hansen P. Familial defective apolipoprotein B-100. Dannish Med Bull 1998; 45: 370-382.

  29. Robles-Osorio L, Ordóñez ML, Aguilar-Salinas CA, Aurón-Gómez M, Tusié-Luna MT, Gómez-Pérez FJ, Rull-Rodrigo JA. Familial hypercholesterolemia due to a ligand-defective apolipoprotein B-100. First case-report in a Mexican family. Archives of Medical Research 2003; 34: 70-75.

  30. Hopkins P, Heiss G, Ellison C, Province M, Pankow J, Eckfeldt J, Hunt S. Coronary artery disease in familial combined hyperlipidemia and familial hypertriglyceridemia. Circulation 2003; 108: 519-523.

  31. Valles V, Aguilar-Salinas CA, Gómez-Pérez FJ, Rojas R, Franco A, Olaiz G, Rull JA, Sepúlveda J. Apolipoprotein B and AI distribution in the Mexican urban adults: Results of a Nation-Wide Survey. Metabolism 2002; 51: 560-568.

  32. Austin M, McKnight B, Edward K et al. Cardiovascular disease mortality in familial forms of hypertriglyceridemia: A 20 year prospective study. Circulation 2000; 101: 2777-2782.

  33. Sniderman AD, Castro-Cabezas M, Riblata J, Carmena R, de Bruin TWA, de Graaf J, Erkelens DW, Humphries SE, Masana L, Real JT, Talmud PJ, Taskinen MR. A proposal to redefine familial combined hyperlipidemia-Third workshop on FCHL. Eur J Clin Invest 2002; 32: 71-73.

  34. Aguilar-Salinas CA, Rojas R, Gómez-Pérez FJ, Valles V, Franco A, Olaiz G, Sepúlveda J, Rull JA. Características de los casos con dislipidemias mixtas en un estudio de población: Resultados de la Encuesta Nacional de Enfermedades Crónicas. Salud Pública de México 2002; 44: 546-553.

  35. Assmann G, Schulte H, Cullen P. New and classical risk factors-The Munster heart study (PROCAM). Eur J Med Res 1997; 2: 237-242.

  36. Mahley RW, Huang Y, Rall S. Pathogenesis of type III hyperlipoproteinemia (dysbetalipoproteinemia): questions, quandaries, and paradoxes. J Lipid Res 1999; 40: 1933-1949.

  37. Aguilar CA, Botet JP, Ordovas JM, Talavera G, Guillén LE, Barriguete JA, Leco ME, González-Barranco J, Gómez-Pérez FJ, Rull JA. The apolipoprotein E4 allele is not associated with an atherogenic lipid profile in a Native-American population following its traditional lifestyle. Atherosclerosis 1999; 142: 409-414.

  38. Heart Protection Study Collaborative Group MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5,963 people with diabetes: a randomized placebo controlled trial. Lancet 2003; 361: 2005-2016.

  39. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, Langendorfer A, Stein EA, Kruyer W, Gotto AM Jr. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 1615-1622.

  40. Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1353.

  41. The Decode Study Group on Behalf of the European Diabetes Epidemiology Group. Is the current definition for diabetes relevant to mortality risk from all cause and cardiovascular and noncardiovascular disease. Diabetes Care 2003; 26: 688-696.

  42. Lakka H, Laaksonen D, Lakka T. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709-2716.

  43. Girman C, Rhodes T, Mercuri M et al. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study and the Air Force/Texas Coronary Atherosclerosis Prevention Study. Am J Cardiol 2004; 93: 136-141.

  44. Hennekens C, D’Agostino R. Global risk assessment for cardiovascular disease and astute clinical judgement. Euro Heart J 2003; 24: 1899-1903.

  45. Robins S, Bloomfield Rubins H, Faas F, Schaefer E, Elam M, Anderson J, Collin D on behalf of the VA-HIT Study Group. Insulin resistance and cardiovascular events with low, HDL cholesterol. Diabetes Care 2003; 26: 1513-1517.

  46. The ALLHAT officers and coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care. JAMA 2002; 288: 2998-3007.

  47. Grundy SM. Statin trials and goals of cholesterol-lowering therapy. Circulation 1998; 97: 1436-1451.

  48. American Diabetes Association. Dyslipidemia management in adults with diabetes. Diabetes Care 2004; 27(Suppl 1): S68-S71.

  49. The National Academy of Sciences. Dietary references in takes for energy, carbohydrates, fiber, fat, protein and aminoacids 2002. Disponible en www.nap.edu/openboodk/03090085373

  50. Jenkins D, Kendall C, Marchie A et al. Effects of a dietary portfolio of cholesterol lowering foods vs lovastatin on serum lipids and C-Reactive protein. JAMA 2003; 290: 502-510.

  51. Davignon J. The cardioprotective effect of statins. Curr Atheroscler Rep 2004; 6: 27-35.

  52. Bruckert E, Giral P, Tellier P et al. Perspectives in cholesterol therapy: the role of ezetimibe, a new selective inhibitor of intestinal cholesterol absorption. Circulation 2003; 107: 3124-3128.

  53. Athyros VG, Papageorgiou AA, Hatzikonstandinou HA, Didangelos TP, Carina MV, Kranitsas DF, Kontopoulos AG. Safety and efficacy of long-term statin-fibrate combinations in patients with refractory familial combined hyperlipidemia. Am J Cardiol 1997; 80: 608-613.

  54. Fruchart JC. The science behind statins and fibrates. Int J Clin Pract 2002; (Suppl) 132: 11-16.




2020     |     www.medigraphic.com