Différences entre versions de « Dyslipidémie »
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* [[Anévrisme aortique]] | * [[Anévrisme aortique]] | ||
| − | High-intensity statin therapy should be initiated in patients with ASCVD who are aged 75 years or younger to achieve a reduction in LDL cholesterol of 50% or greater. | + | ; → High-intensity statin therapy should be initiated in patients with ASCVD who are aged 75 years or younger to achieve a reduction in LDL cholesterol of 50% or greater. |
| − | If high-intensity statin therapy is contraindicated or not tolerated, moderate-intensity statin therapy should be initiated to achieve a reduction in LDL cholesterol of 30% to 49%. | + | ; → If high-intensity statin therapy is contraindicated or not tolerated, moderate-intensity statin therapy should be initiated to achieve a reduction in LDL cholesterol of 30% to 49%. |
== Laboratoire == | == Laboratoire == | ||
Version du 2 juin 2020 à 11:03
Dépistage
- Recommandé chez tous les adultes entre 40 et 75 ans[1]
Diagnostic différentiel
- Hypothyroïdie
- Diabète non contrôlé
- Syndrome néphrotique
- Médicaments: glucocorticoïdes, diurétiques, amiodarone
Stratification du risque cardiovasculaire
Calcul: https://www.agla.ch/fr/calculateurs-outils/calculateur-de-risque-du-gsla
Prévention primaire
Sans calcul du score de risque (Framingham) au préalable:[2]
- Adults of any age with an LDL cholesterol level of 4.92 mmol/L or higher should be started on high-intensity statin therapy
- Adults aged 40 to 75 years with diabetes should be started on moderate-intensity statin therapy.
- In adults aged 40 to 75 years who have at least one ASCVD risk factor (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year ASCVD risk of 10% or greater, the U.S. Preventive Services Task Force (USPSTF) recommends statin therapy for the primary prevention of ASCVD.
Avec calcul du score de risque (Framingham) au préalable
- Patients with a 10-year risk for ASCVD of 20% or higher.
Prévention secondaire
Chez les patients suivants (= atteints d'ASCVD):
- Syndrome coronarien aigu
- Antécédent d'infarctus du myocarde
- Angor stable et instable
- Antécédent de revascularisation artérielle (coronarienne ou autre)
- Antécédent d'AVC ou AIT
- AOMI attribuable à l'athérosclérose
- Anévrisme aortique
- → High-intensity statin therapy should be initiated in patients with ASCVD who are aged 75 years or younger to achieve a reduction in LDL cholesterol of 50% or greater.
- → If high-intensity statin therapy is contraindicated or not tolerated, moderate-intensity statin therapy should be initiated to achieve a reduction in LDL cholesterol of 30% to 49%.
Laboratoire
- ALAT uniquement avant l'introduction d'une statine
- Tests hépatiques complets et CK seulement si symptômes ou avant d'initier le traitement chez un patient à risque (myopathie)
Suivi
- Profil lipidique 4-12 semaines après l'introduction du traitement
- Puis profil lipidique aux 3 mois/12 mois
Hypertriglycéridémie
- Xanthomes éruptifs (surface des extenseurs, fesses) -> pathognomoniques d'une hypertriglycéridémie
Références
- ↑ The U.S. Preventive Services Task Force (USPSTF) recommends universal lipid screening in adults aged 40 to 75 years to calculate risk for atherosclerotic cardiovascular disease (ASCVD) using the American Heart Association (AHA)/American College of Cardiology (ACC) Pooled Cohort Equations
- ↑ https://mksap18.acponline.org/app/topics/gm/mk18_b_gm_s9/mk18_b_gm_s9_2_2
