By Dr Mujahidah Naim

Introduction
 Atherosclerosis cause by hypercholesterolemia,
smoking, an elevated blood pressure and
inflammation.
2. MEASUREMENT OF LIPID LEVELS

 Serum lipid levels are affected by several

factors: acute stress or illness, eg fever,
surgery, acute myocardial infarction, drugs eg
beta-blockers, thiazides, steroids.
 Total cholesterol (TC) and high density
cholesterol (HDL-C) can be measured in both
fasting and non fasting states.
 Triglycerides (TG) should be measured after
10-12 hours of fasting.
Classification of
Dyslipidaemias
 Primary
 Secondary
GLOBAL CARDIOVASCULAR RISK
ASSESSMENT
 All adults (above the age of 20 years) should
have a complete fasting lipid profile
 (TC, LDL-C, HDL-C, TG). The individual’s level
of risk in developing CHD should then be
assessed.
 Individuals with 0-1 risk factors almost always
have a 10 year CHD risk < 10%.
 Individuals with 2 or more risk factors can fall
into one of the following risk categories for
developing CHD over 10 years:
 · >20%
 · 10-20 %
 · <10%
CHD And CHD Risk Equivalents

 Individuals with CHD and CHD risk equivalents

belong to the highest risk category.
 The CHD risk equivalents are:
Other clinical forms of atherosclerotic disease –
( peripheral vascular disease, abdominal aortic
aneurysm, symptomatic carotid artery disease)
 · Diabetes mellitus
 · Multiple risk factors that confer a 10 year risk
for CHD > 20%
MANAGEMENT OF DYSLIPIDAEMIA

 THERAPEUTIC LIFESTYLE CHANGES

Dietary Modification

 saturated fatty acids (SFA) raise LDL

 monounsaturated fatty acids (MUFA) and
polyunsaturated fatty acids (PUFA) lower
LDL
 A high intake of carbohydrate (> 60% of total
caloric intake) results in a reduction in HDL-C
and a rise in TG levels
PUFA
 The use of viscous (soluble) forms of dietary
fibre (oats, pectin, guar and psyllium) of at
least 5 – 10 gm per day is encouraged as they
have been shown to reduce LDL
 Plant stanol/sterol esters (2 – 3 gm/day) also
have an LDL
 High intake of soy protein (25 - 50 gm/day)
can cause small reductions in LDL. Its role is
mainly to help reduce the intake of animal
food products containing animal fats.
Weight Reduction

 A weight reduction of 0.5-1.0 kg per week is

recommended.
 According to the Asia Pacific World Health
Organization, the recommended BMI is < 23
kg/m2 and
 a waist circumference < 95 cm for males and
< 80 cm for females.
Physical Activity

 Exercise needs to be regular and adequate (at

least 30-45 minutes
 per session 3x a week).
Cigarette Smoking

 Smoking is one of the major risk factors for

CHD and must be stopped. Even
 passive smokers are at high risk of developing
CHD. The decline in CHD risk
 begins a few months after smoking cessation.
Miscellaneous

 Omega–3 polyunsaturated fatty acids are

useful in individuals with high TG
Drug therapy

 In those with established CHD and CHD risk

equivalents, drug treatment will
 need to be initiated from the outset in
conjunction with TLC
 Renungan…..
Surah Nur ayat 35
 Allah yang menerangi langit dan bumi. Bandingan
nur hidayah pertunjuk Allah (Kitab Suci Al-Quran)
adalah sebagai sebuah "misykaat" yang berisi
sebuah lampu; lampu itu dalam gelok kaca
(gandil), gelok itu pula (jernih terang) laksana
bintang yang bersinar cemerlang;
 lampu itu dinyalakan dengan minyak dari pokok
yang banyak manfaatnya, (iaitu) pokok zaitun
yang bukan sahaja disinari matahari semasa
naiknya dan bukan sahaja semasa turunnya
(tetapi ia sentiasa terdedah kepada matahari);
hampir-hampir minyaknya itu - dengan sendirinya
- memancarkan cahaya bersinar (kerana
jernihnya) walaupun ia tidak disentuh api
 (sinaran nur hidayah yang demikian bandingannya
adalah sinaran yang berganda-ganda): cahaya
berlapis cahaya. Allah memimpin sesiapa yang
dikehendakiNya (menurut undang-undang dan
peraturanNya) kepada nur hidayahNya
THE OLIVE: A HEALTH-GIVING
PLANT
 most highly recommended types of oil by all
experts, especially for coronary and arterial
health.
 Mono-unsaturated fatty acids do not contain
cholesterol.
 contains omega-6 linoleic acid (EFA: essential
fatty acid)
 lower LDL (bad cholesterol) and higher
antioxidant levels in people who consume 25
millilitres (about two dessertspoonfuls) of
natural olive oil a day for one week.
 raises that of useful cholesterol (HDL)
 A recent study by doctors at the University of
Oxford has shown that olive oil has a
protective effect against intestinal cancer.
 Olive oil has a protective effect against some
types of malignant tumors: prostate, breast,
colon, squamous cell, and oesophageal.
 The vitamins E, A, D and K contained in olive
oil are particularly important from the point
of view of assisting bone development in
adults and children, and in strengthening the
bones by fixing calcium.
 Since the vitamins contained in olive oil have
a cell renewing effect they are also employed
in the treatment of the elderly
 people who consume large quantities of olive
oil and cooked vegetables can have a reduced
risk of rheumatic arthritis
 Olive oil prevents insulin resistance and
ensures better control of the glucose in the
blood.
 Dietary intake of olive oil polyphenols may
lower the risk of reactive oxygen metabolite-
mediated diseases such as some
gastrointestinal diseases and atherosclerosis.
Surah An-Nahl ayat 11

 Ia juga menumbuhkan bagi kamu dengan

sebab hujan itu tanam-tanaman dan pokok-
pokok zaitun dan tamar (korma) serta anggur
dan juga dari segala jenis buah-buahan.
Sesungguhnya yang demikian mengandungi
satu tanda (yang membuktikan kekuasaan
Allah) bagi kaum yang mahu berfikir.