Atherosclerotic Cardiovascular Disease is one of the top contributors to deaths globally and locally.

Atherosclerosis is a general term for many different disorders that result from a thickening and loss of elasticity in the arterial wall. This damage leads to the formation of plaque in the blood vessels causing ASCVD, which includes stroke, heart attacks and damage to peripheral arteries.  

The top 3 risk factors for ASCVD are high LDL-C (low-density lipoprotein-cholesterol), high blood pressure and diet.

LDL-C or cholesterol causes plaque to build up in the blood vessels and results in an increase in the risk of a person having an ASCVD event.

There are several risk factors that are used in identifying the risk of the Filipino individual for cardiovascular disease:

• Male sex
• Postmenopausal women
• History of smoking
• Hypertension
• Body Mass Index > 25 kg/m2
• Family History of Premature Coronary Heart Disease 
• Proteinuria
• Left Ventricular Hypertrophy

A Filipino individual has 2 or more of these risk factors, they should undergo testing for their cholesterol levels as they may already need to begin maintenance medications to reduce their risk.

Elevated cholesterol usually does not exhibit any symptoms. The condition is identified when an individual undergoes testing for their cholesterol levels.

However, if the condition remains unchecked, the individual may progress to experiencing an ASCVD event which are commonly identified as:

Heart Attack or Myocardial Infarction

• Chest pain or discomfort
• Feeling weak, light-headed or faint
• Discomfort in the jaw, neck or back
• Pain or discomfort in one or both arms or shoulders
• Shortness of breath

Stroke

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking, or difficulty understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination
• Sudden severe headache with no known cause

Peripheral Artery Disease

• Painful cramping in one or both of your hips, thighs, or calf muscles after certain activities, such as walking or climbing stairs
• Leg numbness or weakness
• Coldness in your lower leg or foot, especially when compared with the other side
• Sores on your toes, feet or legs that won’t heal
• A change in the color of your legs
• Hair loss or slower hair growth on your feet and legs

No pulse or a weak pulse in your legs or feet 

Diagnostics

• Lipid Profile: Total Cholesterol, LDL-C, HDL

Treatment: The goal of treatment is for patients to achieve their target LDL-C goals according to their risk profile. Achieving these goals will lower the patients’ risk for cardiovascular events such as a heart attack or stroke.

• Statins: The use of statins for individuals with no clinical ASCVD (primary prevention) is recommended for patients aged 45 years and above with 2 or more risk factors with and LDL-C > 130 mg/dL. Statins are also recommended for patients with diabetes mellitus, and those with acute coronary syndrome.
• Ezetimibe: This is an important adjunct medication in lowering LDL-C in the body. It is to be given to patients on maximally tolerated statin therapy but not at goal LDL-C levels.
• PCSK9-inhibitors: These medications also work in adjunct to statin therapy. Like ezetimibe, they may also be given to patients on maximally tolerated statin therapy but who are not achieving their goal LDL-C levels.

Fibrates: Adding fibrates to statins may be considered among those with controlled diabetes, low HDL-C (<35 mg/dL) and persistently high triglycerides (>200 mg/dL) for prevention of cardiovascular disease.

For individuals at any level of cardiovascular risk, the following are recommended:

• Low-fat, low-cholesterol diet – a Filipino individual may utilize the Pinggang Pinoy method which is a serving plate where half of the portion is of green and leafy vegetables, one-fourth serving of meat and the rest are fiber-rich carbohydrates
• Cigarette smoking cessation – the use of vaping or e-cigarettes is also not recommended
• Exercising at least 150 minutes per week at moderate to high-intensity

Consult your doctor for the proper laboratory diagnostic tests to be done, and if any medications should be started

References:

2020 Executive Summary of the Clinical Practice Guidelines for the Management of Dyslipidemia in the Philippines

Center for Disease Control and Prevention (CDC, 2022)

Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series (Journals of the American College of Cardiology, 2018)