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.