Cholesterol: how to measure and how to treat
Raised lipid levels are a significant risk factor for cardiovascular disease. Alison Pottle provides an overview of how these are measured and the lifestyle measures and medications that can be used to reduce risk in these patients
Cardiovascular disease (CVD) is the leading cause of death in England and Wales. Raised lipid levels are a significant risk factor for CVD. Lipids are a heterogeneous group of substances which include cholesterol, triglycerides, lipoproteins and apolipoproteins. The link between increased lipid levels and atherosclerosis was first established in the early 1900s. Numerous clinical studies have demonstrated the critical role of low density lipoproteins and other cholesterol-rich apolipoprotein-B containing lipoproteins in atherosclerotic plaque formation and the subsequent risk of CVD events. There is now clear indication that the lower the achieved LDL levels, the lower the risk of CVD. Multiple interventions including changes in lifestyle together with the use of lipid-lowering therapies may be required to achieve desired lipid levels, and practice nurses can play a key role in this. This article will discuss how cholesterol levels are measured and the treatment strategies now available.
Cardiovascular disease (CVD), of which atherosclerotic cardiovascular disease (ASCVD) is the major component, is responsible for more than 4 million deaths in Europe annually (Mach et al, 2020). It is the cause of death for more women than men (2.2 million versus 1.8 million), although CV deaths before the age of 65 years are more common in men than in women (490 000 versus 193 000) (Townsend et al, 2015). The major risk factors for ASCVD, which have been identified over the past few decades, are blood apolipoprotein-B (APO-B) containing lipoproteins (predominately low-density-lipoproteins [LDL]), elevated blood pressure, cigarette smoking and diabetes mellitus (Visseren et al, 2021). Prevention is defined as a co-ordinated set of actions aimed at eliminating or minimising the impact of CVD and related disabilities (Mach et al, 2020). The importance of ASCVD prevention remains undisputed and needs to be delivered at a general population level by promoting healthy lifestyle behaviour (Cooney et al, 2009), and at an individual level by tackling unhealthy lifestyles and by reducing increased levels of causal risk factors such as cholesterol. Practice nurses have a key role to play in this.
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