Optimal goala mg/dL
Low 10-year risk Moderate 10-year risk High 10-year risk
160 130 100
4.1 3.4 2.6
Table 5 LDLc treatment goals according to categories of risk
Notes: aif these optimal goals are not reached, the minimum reductions in LDLc to be achieved are: 40, 50, and 60%, respectively. Abbreviation: LDLc, low-density lipoprotein cholesterol.
Several intervention studies have clearly demonstrated that a healthy diet reduce cardiovascular risk factors indepen- dently of classic risk factors (Table 2). Moreover, this kind of diet can increase the LDLc-lowering power of drugs.19 The beneficial effect is probably mediated by a variety of mechanisms including improved carbohydrate metabolism, lower blood pressure, greater antioxidant protection, and regulating inflammatory and thrombogenic processes.
In this manuscript, we have reviewed the recently genetic and molecular mechanisms described as target for hypercholes- terolemia and updated FH diagnosis and treatment.
FH has been studied widely since its first description in 1938.2 Despite this knowledge, new mutations and genes implicated in cholesterol pathway, as PCSK9 or Idol,88,91 have been recently associated with hypercholesterolemia. In fact, over 17% ofADH is caused by unknown mechanisms, because of that an exhaustive research in this way has to be done.9
Moreover, an accurate FH clinical diagnosis combined with genetic testing allows physicians to discriminate FH from other dyslipemias.104 The treatment goal in FH for decreasing CHD risk is LDLc levels but not denying the benefits obtained with lifestyle changes that reduce the environmental risk factors.
This work has been partially funded by grants FIS PS09/00665, PI06/1238, and PSE 010000-2008-5.
The authors report no conflicts of interest in this work.
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