MANAJEMEN TERPADU

DISLIPIDEMIA
Farid Kurniawan

Divisi Metabolik Endokrin

Departemen Ilmu Penyakit Dalam FKUI-RSCM
April 2017
What is dyslipidemia?

Disorder in lipid metabolism or lipid fraction in plasma

Total Cholesterol, LDL-chol, Triglycerides (TG)
HDL-chol

Types of dyslipidemia:
Primary
Secondary

Konsensus Pengelolaan Dislipidemia di Indonesia. PERKENI 2012

Symptoms and signs

Usually no symptoms
Symptomatic vascular disease
Acute pancreatitis
LDL:
arcus corneae
tendinous xanthomas (Achilles, elbow, and knee tendons and
over metacarpophalangeal joints)
TC:
Above findings (+) planar and tuberous xanthomas
Diagnosis and screening

Lipid profile measurement

Direct method: TG, HDL-chol, TC
Direct or indirect method: LDL-chol
Fasting:
Is it necessary?
For how long?
Evaluation for secondary dyslipidemia
When do we screen?
Age >20 yrs old, if normal repeat every 5 year
Dyslipidemia as cardiovascular
risk factor
Total risk estimation using a risk estimation system: SCORE
asymptomatic adults >40 years of age
Making logical management decisions
Avoid both under- and overtreatment
Certain individuals already with high or very high CVD risk
without needing risk scoring:
Previously documented CVD
Diabetes
Chronic kidney disease
Familial hypercholesterolemia

2016 ESC/EAS Guidelines on the management of dyslipidemias

Risk categories

2016 ESC/EAS Guidelines on the management of dyslipidemias

Intervention strategies

*In patients with myocardial infarction, statin therapy should be considered

irrespective of total cholesterol levels
2016 ESC/EAS Guidelines on the management of dyslipidemias
Faktor Risiko Utama yang Menentukan
Sasaran Kolesterol LDL

Merokok
Hipertensi (TD 140 / 90 mmHg atau sedang mendapat obat
antihipertensi)
Kolesterol HDL (40 mg/dL)
Riwayat keluarga adanya PJK dini (orang tua pria <55 tahun,
orang tua wanita <65 tahun)
Umur (pria 45 tahun, wanita 55 tahun)

Konsensus Pengelolaan Dislipidemia di Indonesia. PERKENI 2012

 Empat Kelompok Risiko yang Menentukan
Sasaran Kolesterol LDL yang Ingin Dicapai
RISIKO RENDAH

0 1 faktor risiko

RISIKO MULTIPEL

>= 2 faktor risiko

RISIKO TINGGI

a. Mempunyai riwayat PJK

b. Mempunyai risiko yang disamakan dengan PJK:
Diabetes melitus
Penyakit aterosklerosis lain seperti stroke, PAD, aneurisma aorta abdominalis
Faktor risiko multipel (>2 faktor risiko)
RISIKO SANGAT TINGGI

Pasien pasca penyakit kardiovaskuler dengan keadaan khusus, yaitu:

Disertai faktor risiko multipel
Disertai faktor risiko yang tidak dapat dikendalikan, seperti masih tetap merokok
Sindrom metabolik dengan faktor risiko multipel (TG 200 mg/dL, Kolesterol non-HDL >130
mg/dL, Kolesterol HDL <40 mg/dL)
Pasien dengan sindrom koroner akut

Konsensus Pengelolaan Dislipidemia di Indonesia. PERKENI 2012

Dyslipidemia in metabolic syndrome and
type 2 diabetes

2016 ESC/EAS Guidelines on the management of dyslipidemias

Treatment of dyslipidemia in diabetes

2016 ESC/EAS Guidelines on the management of dyslipidemias

Dyslipidemia management
based on NCEP-ATP III

(Konsensus pengelolaan
dislipidemia 2015
PERKENI)
Dyslipidemia management
based on ACC/AHA 2013

(Konsensus pengelolaan
dislipidemia 2015
PERKENI)
Systematic review & meta-analysis of the
therapeutic equivalence of statins

Weng TC, et al. J Clin Pharm Ther. 2010;35;139-151

Mukhtar RY, et al. Int J Clin Pract. 2005;59(2):239-252
Treatment targets and goals for cardiovascular
disease prevention

2016 ESC/EAS Guidelines on the management of dyslipidemias

Impact of specific lifestyle changes on lipid levels (1)

2016 ESC/EAS Guidelines on the management of dyslipidemias

Impact of specific lifestyle changes on lipid levels (2)

2016 ESC/EAS Guidelines on the management of dyslipidemias

Impact of specific lifestyle changes on lipid levels (3)

2016 ESC/EAS Guidelines on the management of dyslipidemias

Advanced marker for
dyslipidemia
Small dense LDL
Non-HDL cholesterol
ApoB (apolipoprotein-B100)
Lipoprotein-a [Lp(a)]

What are the roles??

TERIMA KASIH
Dietary recommendations to tower LDL-cholesterol

2016 ESC/EAS Guidelines on the management of dyslipidemias