Control of Lipids

My first technically oriented blog today.

Dyslipidemia is very common in the affluent world.We in India and also most of Asia have an excess of the bad cholesterol [LDL ]as well as an increase in the Triglycerides,due to genetic factors or nowadays due to urbanisation and the ills of modernisation.Both are independant risk factors for cardiac events.Patients being symptom free are unaware of their problems until tested and hence are at the highest risk.Control of lipids is based on trials conducted basically by the western world. Cholesterol is controlled by statins and Triglycerides by fibrates.

Last night I attended a CME on"Newer paradigm in Lipid Management and Antiplatelet Therapy", sponsored by Shreya Life Sciences.The speakers were two eminent intervention cardiologists,Dr D Kumbla and Dr.S Shetty.The role of aspirin and statins were discussed on a more theoretical basis interspersed with few case experiences.It was a sort of revision for me of the various studies conducted worldwide as these topics are regularly presented at various CMEs.

Now for some personal experiences and trials that I have conducted and which was discussed in the Question Answer session conducted at the end. As a family physician,I deal mostly with primary prevention of cardiovascular problems.The patients are usually in midlife or nowadays even in late 30s due to the hectic lifestyles and stress.On routine screening they are usually uncomplicated cases, detected for the first time for impaired fasting sugar or glucose intolerance or dyslipidemia.They may or may not have hypertension,may or may not be overweight or obese.The advise is standardised text book like.Lifestyle modification like diet and exercise,giving up tobacco,control over alcohol, weight reduction and the medicines.

Here I am writing about medicines only in Lipids control.I put the patients on a daily dose of 10mg atorvastatin and 160 mg of fenofibrate for those having both high LDL and Triglycerides..I have noticed that my patients respond extremely well to 10 mg statin and I have never had to titrate the dose or add Ezetimibe.Cardiologist always recomend a combination of statin and Ezetemibe in all CMEs probably because they mostly see post event cases and are on secondary prevention.In the first follow up in 1 to 3 months,on seeing good control, I advise them to take a statin alternate day as on Monday,Wednesday and Friday and a Fibrate on Tuesday,Thursday and Saturday with a holiday on Sunday.Even with this pattern I have seen good control over the past few years followup.The positive thing is a greater patient compliance and better tolerability of the drugs as they have lesser side effects which are mostly general weakness and abdominal pains.I have not seen any case with the side effect of myopathy or rhabdomyolisis with these doses.

This was discussed in yesterday's CME and the cardiologists agreed that though this alternate day dosage is not studied or documented it is alright to have this regime as long as the patients are under regular supervision and followup.

I would like to know if any clinician has treated dyslipidemia in this way and their experiences. I have not been able to document my experiences due to lack of time in our setup of general practise.