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Dyslipidemi, hyperlipidemi

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Olika lipidrubbningar med ofördelaktig fördelning av lipider som ger ökad risk för hjärt-kärlsjukdom.
Förekomst:
Det finns inga tydliga siffor men tillståndet bedöms vara vanligt förekommande. Ärftliga former är sällsynta men kan leda till hjärt-kärlsjukdom i tidig ålder.
Symtom:
Dyslipidemi är en riskfaktor utan symtom, men vid ställd diagnos är det viktigt att gå igenom andra faktorer som kan öka risken för framtida hjärt-kärlsjukdomar.
Kliniska fynd:
Ger oftast inga fynd men vid mycket höga kolesterolvärden kan patienten ha ansamlingar av kolesterol kring sträcksidor och kring ögonen. Vid ställd diagnos är det viktigt att gå igenom tecken på hjärt-kärlsjukdom och fynd som kan öka risken för hjärt-kärlsjukdom.
Diagnostik:
Diagnostiken bygger på att dela in patienter i olika riskgrupper som styr indikationen för kolesterolsänkande behandling. Patienter med konstaterad hjärt-kärlsjukdom har alltid indikation för kolesterolsänkande behandling.  
Behandling:
Såväl livstilsbehandling som farmakologisk behandling ingår i grupper med hög och mycket hög risk för hjärt-kärlsjukdom. Statiner har störst evidens för sänkning av kolesterolnivåer och sänkning av risken för hjärt-kärlsjukdom.
  1. Socialstyrelsen – Folkhälsorapport 2009. www.socialstyrelsen.se  
  2. Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal 2019. doi:10.1093/eurheartj/ehz455 DOI  
  3. Wierzbicki AS, Humphries SE, Minhas R on behalf of the Guideline Development Group. Familial hypercholestertolaemia: summary of NICE guidance. BMJ 2008; 337: a1095. PubMed  
  4. Aterosklerotisk hjärt-kärlsjukdom (2014). Läkemedelsverket (Hämtad 2017-02-10). lakemedelsverket.se  
  5. Liu C, Dhindsa D, Almuwaqqat Z, et al. Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations. JAMA Cardiol 2022. pmid:35583863 PubMed  
  6. Kane JP, Havel RJ. Disorders of the biogenesis and secretion of lipoproteins containing the B apolipoproteins. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The metabolic and molecular bases of inherited disease, 7th edn. New York: McGraw-Hill, 1995; 1853-85.
  7. Durrington P. Dysplipidaemia. Lancet 2003; 362: 717-31. PubMed  
  8. Bhatnagar D, Morgan J, Siddiq S, Mackness MI, Miller JP, Durrington PN. Outcome of case finding among relatives of patients with known heterozygous familial hypercholesterolaemia. BMJ 2000; 321: 1497-500. British Medical Journal  
  9. Cooney MT, Selmer R, Lindman A, et al. Cardiovascular risk estimation in older persons: SCORE O.P. Eur J Prev Cardiol 2016;23: 1093–1103. PMID:26040999 . PubMed  
  10. Christoffersen M, Frikke-Schmidt R, Schnohr P, et al. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in generel population. BMJ 2011; 343: d5497. BMJ (DOI)  
  11. Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA 2007; 298: 776-85. Journal of the American Medical Association  
  12. Marston NA, Giugliano RP, Melloni GE, et al. Association of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis Distinguishing Between Particle Concentration, Type, and Content. JAMA Cardiol 2021. pmid:34773460 PubMed  
  13. Att förebygga aterosklerotisk hjärt-kärlsjukdom med läkemedel – behandlingsrekommendation. Information från Läkemedelsverket 2014;25(5):20–33. lakemedelsverket.se  
  14. Janusinfo (Region Stockholm). Statiner och tilläggsbehandlingar för kardiovaskulär prevention hos högriskpatienter med ordinära till måttligt förhöjda lipidnivåer. Uppdaterat 2023-01-09 (Hämtad 2023-02-27). janusinfo.se  
  15. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J (2016) 37 (39): 2999-3058. PMID:27567407. PubMed  
  16. Cooper A, O'Flynn N. Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance. BMJ 2008; 336: 1246-8. British Medical Journal  
  17. DEGAM. Leitlinien der DEGAM. Inget datum (Hämtad 2022-10-06). www.degam.de  
  18. NHS England. Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD. Dec 2021 (Hämtad 2022-10-06). www.england.nhs.uk  
  19. Ebrahim S, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev, issue 2, 2000. The Cochrane Library  
  20. Kelly RB. Diet and exercise in the management of hyperlipidemia. Am Fam Physician 2010; 81: 1097-1102. American Family Physician  
  21. Varady KA, Jones PJ. Combination diet and exercise interventions for the treatment of dyslipidemia: an effective preliminary strategy to lower cholesterol levels? J Nutr 2005; 135: 1829-35. PubMed  
  22. Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008; 108: 287-331. PubMed  
  23. Sabaté J, Oda K, Ros E. Nut consumption and blood lipid levels. A pooled analysis of 25 intervention trials. Arch Intern Med 2010; 170: 821-7. PubMed  
  24. Griel AE, Kris-Etherton PM. Tree nuts and the lipid profile: a review of clinical studies. Br J Nutr 2006; 96(suppl 2): S68–S78.
  25. Mukuddem-Petersen J, Oosthuizen W, Jerling JC. A systematic review of the effects of nuts on blood lipid profiles in humans. J Nutr 2005; 135: 2082-9. PubMed  
  26. Liu JP, Zhang J, Shi Y, Grimsgaard S, Alraek T, Fønnebø V. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med 2006; 1: 4. PubMed  
  27. Schoeneck M, Iggman D. The effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trials. Nutr Metab Cardiovasc Dis. 2021;31(5):1325-1338. PMID:33762150. PubMed  
  28. Brunner EJ, Rees K, Ward K, Burke M, Thorogood M. Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews, issue 4, 2007. The Cochrane Library  
  29. Nordmann AJ, Nordmann A, Briel M, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166: 285-93. PubMed  
  30. Ellison RC, Zhang Y, Qureshi MM, Knox S, Arnett DK, Province MA; Investigators of the NHLBI Family Heart Study. Lifestyle determinants of high-density lipoprotein cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study. Am Heart J 2004; 147: 529-35. PubMed  
  31. Cai L, Ma D, Zhang Y, et al. The effect of coffee consumption on serum lipids: a meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2012;66(8):872–877. PMID:22713771. PubMed  
  32. Halbert JA, Silagy CA, Finucane P, Withers RT, Hamdorf PA. Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. Eur J Clin Nutr 1999; 53: 514-22. PubMed  
  33. Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med 2007; 167: 999-1008. PubMed  
  34. Kelley GA, Kelley KS, Franklin B. Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials. J Cardiopulm Rehabil 2006; 26: 131-9. PubMed  
  35. Leon AS, Gaskill SE, Rice T, et al. Variability in the response of HDL cholesterol to exercise training in the HERITAGE Family Study. Int J Sports Med 2002; 23: 1-9. PubMed  
  36. Olsson AG, Schwartz GG. Early initiation of treatment with statins in acute coronary syndromes. Ann Med 2002; 34: 37-41. PubMed  
  37. Blodfettsrubbningar (2016). FYSS 2015. (Hämtad 2017-03-02) www.fyss.se  
  38. Slentz CA, Houmard JA, Johnson JL, et al. Inactivity, exercise training and detraining, and plasma lipoproteins. STRRIDE: a randomized, controlled study of exercise intensity and amount. J Appl Physiol 2007; 103: 432-42. PubMed  
  39. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet 1994; 344: 1383-9. PubMed  
  40. Foster C, Murphy M, Nicholas JJ, Pignone M, Bazian Ltd. Cardiovascular disorders. Primary prevention. Accessed online December 16, 2004.
  41. Bucher HC, Griffith LE, Guyatt GH. Systematic review on the risk and benefit of different cholesterol-lowering interventions. Arterioscler Thromb Vasc Biol 1999; 19: 187-95. PubMed  
  42. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623-30. PubMed  
  43. The ALLHAT Officers and Co-ordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomised to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002; 288: 2998-3007. Journal of the American Medical Association  
  44. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267-78. PubMed  
  45. Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of datat from 170,000 participants in 26 randomised trials. Lancet 2010; 376: 1670-81. PubMed  
  46. Hebert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol lowering with statin drugs, risk of stroke, and total mortality: an overview of randomised trials. JAMA 1997; 278: 313-21. Journal of the American Medical Association  
  47. Smilde TJ, van Wissen S, Wollersheim H, Trip MD, Kastellein JJP, Stallenhoef AFH. Effect of aggressive versus conventional lipid lowering on atherosclerosis progression hypercholesterolaemia (ASAP): a prospective, randomised, double-blind trial. Lancet 2001; 357: 577-81. PubMed  
  48. Heart Protection Study Collaborative Group MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial, Lancet 2002; 360: 7-22.
  49. Leng GC, Price JF, Jepson RG. Lipid-lowering for lower limb atherosclerosis. Cochrane Database Syst Rev, issue 3, 2004. The Cochrane Library  
  50. Hawkes N. Could giving statins to over 75s really save 8000 lives a year?. BMJ 2019; 365: I1779. pmid:30996024 PubMed  
  51. Cheung BMY, Lam KSL. Never too old for statin treatment. Lancet 2019; 393(10170): 379-380. pmid:30712888 PubMed  
  52. Mortensen MB, Nordestgaard BG. Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70-100 years: a contemporary primary prevention cohort. Lancet. 2020;396(10263):1644-1652. PMID:33186534. PubMed  
  53. Gencer B, Marston NA, Im K, et al. Efficacy and safety of lowering LDL cholesterol in older patients: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2020;396(10263):1637-1643. PMID:33186535. PubMed  
  54. Wood FA, Howard JP, Finegold JA, et al. N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects. N Engl J Med. 2020;383(22):2182-2184. PMID:33196154. PubMed  
  55. Herrett E, Williamson E, Brack K, et al. Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials. BMJ. 2021;372:n135. PMID:33627334. PubMed  
  56. Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010; 340: c2197. BMJ (DOI)  
  57. Sattar NA, Ginsberg H, Ray K, et al. The use of statins in people at risk of developing diabetes mellitus: evidence and guidance for clinical practice. Atheroscler Suppl. 2014 Jun;15(1):1-15. doi: 10.1016/j.atherosclerosissup.2014.04.001. DOI  
  58. Abourbih S, Filion KB, Joseph L, et al. Effect of fibrates on lipid profiles and cardiovascular outcomes: A systematic review. Am J Med 2009; 122: 962.e1-8.
  59. Bhatt DL, Steg G, Miller M, et al for the REDUCE-IT Investigators. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med 2019; 380: 11-22. pmid:30415628 PubMed  
  60. The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 2011; e-pub. www.nejm.org  
  61. Taylor AJ, Villines TC, Stanek EJ, et al. Extended-release niacin or ezetimib and caroptis intima-media thickness. N Engl J Med 2009; 361: 2113-22 . New England Journal of Medicine  
  62. Regionernas samverkansmodell för läkemedel. Leqvio (inklisiran) för behandling av hyperkolesterolemi. 2022-09-28 (hämtad 2022-11-07). janusinfo.se  
  63. Versmissen J, Oosterveer DM, Yazdanpanah M, et al. Efficacy of statins in familial hypercholesterolaemia: a long term cohort study. BMJ 2008; 337: a2423. BMJ (DOI)  
  64. Vuorio A, Kuoppala J, Kovanen PT, et al. Statins for children with familial hypercholesterolemia. Cochrane Database Syst Rev. 2014 Jul 23;7:CD006401. doi: 10.1002/14651858.CD006401.pub3. DOI  
  65. Luirink IK, Wiegman A, Kusters DM, et al. 20-Year Follow-up of Statins in Children with Familial Hypercholesterolemia. N Engl J Med 2019; 381(16): 1547-1556. pmid:31618540 PubMed  
  66. Cuchel M, Bruckert E, Ginsberg HN, et al. Homozygous familial hypercholesterolaemia: new insightsand guidance for clinicians to improve detection and clinical management.A position paper from the Consensus Panel on Familial Hypercholesterolaemia ofthe European Atherosclerosis Society. Eur Heart J 2014:35:2146–2157. PMID:25053660. PubMed  
  67. Raal FJ, Hovingh GK, Catapano AL. Familial hypercholesterolemia treatments: Guidelines and new therapies. Atherosclerosis 2018; 277: 483-92. pmid:30270089 PubMed  
  68. Thompson GR, Miller JP, Breslow JL. Improved survival of patients with homozygous familial hypercholesterolaemia treated with plasma exchange. BMJ 1985; 295: 1671-73. British Medical Journal  
  69. Kajinami K, Mabuchi H. Therapeutic effects of LDL apheresis in the prevention of atherosclerosis. Curr Opin Lipidol 1999; 10: 401-06.
  70. Wiklund O. Även hos äldre kan sänkt LDL ge minskad risk för hjärtsjukdom. Lakartidningen.se 2021-03-24. lakartidningen.se  
  71. Guedeney P, Giustino G, Sorrentino S, et al. Efficacy and safety of alirocumab and evolocumab: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J. 2019 Jul 3. pii: 5527995. PMID: 31270529 PubMed  
  72. Sharma M, Ansari MT, Abou-Setta AM, et al. Systematic review: comparative effectiveness and harms of combination therapy and monotherapy for dyslipidemia. Ann Intern Med 2009; 151: 622-30. PMID:19884623. PubMed  
  73. Rader DJ, Hovingh GK. HDL and cardiovascular disease. Lancet. 2014 Aug 16;384(9943):618-25. doi: 10.1016/S0140-6736(14)61217-4. DOI  
  74. Singh IM, Shishehbor MH, Ansell BJ. High-density lipoprotein as a therapeutic target. A systematic review. JAMA 2007; 298: 786-98. PubMed  
  75. Briel M, Ferreira-Gonzales I, You JJ, et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: a systematic review and meta-regression analysis. BMJ 2009; 338: b92. BMJ (DOI)  
  76. Sabatine MS, Wiviott SD, Im K, et al. Efficacy and safety of further lowering of low-density lipoprotein cholesterol in patients starting with very low levels: A meta-analysis. JAMA Cardiol 2018. PMID: 30073316 PubMed  
  77. Mundal LJ, Igland J, Veierød MB, et al. Impact of age on excess risk of coronary heart disease in patients with familial hypercholesterolaemia. Heart 2018; 104(19): 1600-1607. pmid:29622598 PubMed  
  78. Janusinfo (Region Stockholm). Återinsätt statin efter behandlingsavbrott. Börja med låg dos och titrera upp. Preparatbyte kan underlätta janusinfo.se  
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen

Tidigare sakkunniga

  • Mats Eriksson, docent och överläkare, Kliniken för endokrinologi, metabolism och diabetes, Karolinska universitetssjukhuset