Penatalaksanaan Hiperkolesterolemia berdasarkan ATPIIIDina Maulida Lubis100100329

Dosen Pembimbing:dr. Isti Ilmiati Fujiati, M.Sc, CM-FM

ATP III adalah panel para ahli untuk mendeteksi, mengevaluasi, dan pengobatan kadar kolesterol tinggi pada orang dewasa, menyajikan rekomendasi terkini dari National Cholesterol Education Programs (NCEPs) untuk pengujian atau mengevaluasi kadar kolesterol dan manajemennya. Secara garis besar, rekomendasi dan pendekatan terapi ATP III ini hampir sama dengan ATP II, namun lebih berfokus pada peran pendekatan klinis dalam pencegahan penyakit jantung koroner (PJK). Laporan ini mengidentifikasi low-density lipoprotein (LDL) sebagai target utama terapi dalam menurunkan kolesterol.

Focus on Multiple Risk FactorsDiabetes: CHD risk equivalentFramingham projections of 10-year CHD riskIdentify certain patients with multiple risk factors for more intensive treatmentMultiple metabolic risk factors (metabolic syndrome)Intensified therapeutic lifestyle changes

Modification of Lipid and Lipoprotein ClassificationLDL cholesterol

New Recommendation for Screening/DetectionComplete lipoprotein profile preferredFasting total cholesterol, LDL, HDL, triglyceridesSecondary optionNon-fasting total cholesterol and HDLProceed to lipoprotein profile if TC 200 mg/dL or HDL

Therapeutic diet lowers saturated fat and cholesterol intakes to levels of previous Step IIAdds dietary options to enhance LDL loweringPlant stanols/sterols (2 g per day)Viscous (soluble) fiber (1025 g per day)Increased emphasis on weight management and physical activityMore Intensive Lifestyle Intervention (Therapeutic Lifestyle Changes = TLC)

For patients with triglycerides 200 mg/dLLDL cholesterol: primary target of therapyNon-HDL cholesterol: secondary target of therapy

Non HDL-C = total cholesterol HDL cholesterol

Definition : Risk for major coronary events equal to that in established CHD10-year risk for hard CHD >20%Hard CHD = myocardial infarction + coronary death

10-year risk for CHD 20%High mortality with established CHDHigh mortality with acute MIHigh mortality post acute MI

Other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease)DiabetesMultiple risk factors that confer a 10-year risk for CHD >20%

Pada orang yang memasuki manajemen klinis kolesterol LDL tinggi, manfaat dari penurunan risiko akan hilang jika sindrom metabolik diabaikan. Untuk mencapai manfaat maksimal dari modifikasi beberapa faktor risiko metabolik, keaadan tahan insulin yang mendasari harus menjadi target terapi. Yang paling aman, paling efektif, dan sarana disukai untuk mengurangi resistensi insulin adalah penurunan berat badan pada orang yang kelebihan berat badan dan obesitas dan peningkatan aktivitas fisik. Mengendalikan berat badan dan latihan fisik mengurangi resistensi insulin dan dapat memodifikasi faktor risiko metabolik dengan baik. ATP III dengan demikian menempatkan peningkatan penekanan pada sindrom metabolik dan modifikasi yang menguntungkan melalui perubahan gaya hidup.

Prinsip manajemen terapi menurut ATP III

NutrientRecommended IntakeSaturated fatLess than 7% of total caloriesPolyunsaturated fatUp to 10% of total caloriesMonounsaturated fat Up to 20% of total caloriesTotal fat2535% of total caloriesCarbohydrate5060% of total caloriesFiber2030 grams per dayProteinApproximately 15% of total caloriesCholesterolLess than 200 mg/dayTotal calories (energy)Balance energy intake and expenditure to maintain desirable body weight/ prevent weight gain

Benefits: reduction in total mortality, coronary mortality, major coronary events, coronary procedures, and strokeLDL cholesterol goal:

First StepInitiate LDL-lowering drug therapy (after 3 months of lifestyle therapies)Usual drug optionsStatinsBile acid sequestrant or nicotinic acidContinue therapeutic lifestyle changesReturn visit in about 6 weeks

Second StepIntensify LDL-lowering therapy (if LDL goal not achieved)Therapeutic optionsHigher dose of statinStatin + bile acid sequestrantStatin + nicotinic acidReturn visit in about 6 weeks

Third StepIf LDL goal not achieved, intensify drug therapy or refer to a lipid specialistTreat other lipid risk factors (if present)High triglycerides (200 mg/dL)Low HDL cholesterol (

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