Select Page

Hyperlipidaemia

Jul 27, 2021

Hyperlipidaemia is considered when either of the following criteria are met:

  • Total cholesterol over 200 mg/dl
  • LDL (low density lipoprotein) cholesterol more than 130 mg/dl
  • The ratio of LDL:HDL is more than 5.0
  • Triglycerides more than 150 mg/dl
  • VLDL (very low-density lipoprotein) more than 35 mg/dl

Treatment goals for hyperlipidaemia are:

  • Total cholesterol less than 200 mg/dl
  • LDL cholesterol less than 130 mg/dl
  • Triglyceride less than 150 mg/dl
  • VLDL less than 35 mg/dl
  • In case of diabetes and coronary artery disease aim for LDL cholesterol less than 70 mg/dl

Medications:

Management of hypercholesterolemia:

  • For LDL 130 to 182 mg/dl – tab. Lipikind 10 (Atorvastatin 10 mg) 1 tablet once a day at night or tab. Rosuless 5 (Rosuvastatin 5 mg) 1 tablet once a day at night.
  • For LDL 183 to 188 mg/dl – tab. Lipikind20 (Atorvastatin 20mg) 1 tablet once a day at night or tab. Rosuless 10 (Rosuvastatin 10 mg) 1 tablet once a day at night.
  • For LDL 189 to 202 mg/dl – tab. Lipikind 40 (Atorvastatin 40 mg) 1 tablet once a day at night or tab. Rosuless 20 (Rosuvastatin 20 mg) 1 tablet once a day at night.
  • For LDL more than 203 mg/dl – tab. Atorlip 80 (Atorvastatin 80 mg) 1 tablet once a day at night or tab. Rosuless 40 (Rosuvastatin 40 mg) 1 tablet once a day at night.

Management of hypertriglyceridemia:

  • Serum triglycerides less than 400 mg/dl – tab. Lipikind 10 1 tablet once a day at night. Maximum dose of 80 mg once a  day at night.
  • Serum triglycerides more than 400 mg/dl – combine tab. Lipikind 10 with tab. Fenolip 145 (Fenofibrate 145 mg) once a day at night.
  • Intolerance to statins – tab. Ezetib 10 (Ezetimibe 10 mg) 1 tablet once a day at night.

In case of intolerance to the above treatment or severe side-effects consider alternative treatment as below (these combinations may be less effective but more tolerable).

  • Tab. Tonact Plus (Atorvastatin 10mg + Nicotinic acid 325mg) 1 tablet at night.
  • Tab. Avas-EZ (Atorvastatin 10 mg+ Ezetimibe 10 mg) 1 tablet at night.

Supplementary therapy (for all patients):

  • Cap. Orlica 120 (Orlistat 120 mg) 1 capsule 3 times a day with each main meal.
  • Cap. Flora BC (Lactobacillus supplement) 1 capsule once a day.

General advice:

  • Advise patients to have low fat diet and exercise regularly.
  • Ensure optimum control of diabetes.
  • Recommend patients to lose weight, stop smoking and avoid alcohol.

Investigations:

  • Lipid profile – to check the LDL, triglycerides, LDL/HDL ratios. Repeat levels will be needed to assess responsiveness of the treatments.
  • Thyroid function test – to rule out hypothyroidism (commonly associated with hyperlipidaemia).
  • Liver function test – to monitor the dose of statins.
  • Serum creatinine – to check the renal functions for high risk patients.
  • HbA1C levels – to monitor the diabetes control.

Referral:

Consider further referral to physician if patient fails to respond or presents with other complications. Consider referral to cardiologist if patient presents with cardiac conditions.