From the Guidelines
Cambodia has one of the lowest proportions of individuals in need of blood pressure-lowering medications, which may also reflect a relatively lower prevalence of high cholesterol compared to other countries. When considering high cholesterol management in Cambodia, it's essential to prioritize lifestyle modifications, including a diet low in saturated fats, increased consumption of fruits and vegetables, regular physical activity (aim for 150 minutes weekly), and weight management, as these changes can significantly impact cholesterol levels and overall cardiovascular health 1. If medication is necessary, statins are the first-line treatment, with common options including simvastatin (20-40mg daily), atorvastatin (10-20mg daily), or rosuvastatin (5-10mg daily), although dosing may need to be adjusted for Asian populations due to potential increased sensitivity to these medications.
Key Considerations for High Cholesterol Management in Cambodia
- Lifestyle modifications are the foundation of treatment, focusing on dietary changes, increased physical activity, and weight management.
- Statins are the preferred medication for high cholesterol, with careful consideration of dosing due to potential increased sensitivity in Asian populations.
- Regular monitoring of liver function and lipid profiles is crucial, typically every 3-6 months initially, then annually once stable.
- Cultural factors and traditional beliefs should be taken into account when developing treatment plans to ensure adherence and effectiveness.
- The relatively low proportion of individuals in need of blood pressure-lowering medications in Cambodia, as observed in studies like the one published in Circulation 1, may indicate a lower prevalence of high cholesterol, but this does not diminish the importance of proactive management and prevention strategies.
From the Research
High Cholesterol in Cambodia
- There is no direct evidence available regarding high cholesterol in Cambodia.
- However, studies have shown that statins are effective in reducing low-density lipoprotein cholesterol (LDL-C) levels and are the first-line treatment for hypercholesterolemia 2, 3.
- Additional treatments such as ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and bempedoic acid can be used to achieve lipid targets in patients who do not respond to statin therapy alone 2, 4, 5.
- Physical activity is also recommended as a critical component of first-line treatment for elevated blood pressure or cholesterol, with benefits comparable to other healthy lifestyle changes 6.
- High-intensity statins are recommended for high-risk patients, including those with atherosclerotic cardiovascular disease (ASCVD) or severe hypercholesterolemia, with a goal of reducing LDL-C levels by 50% or greater 5.
Treatment Options
- Statins: effective in reducing LDL-C levels and are the first-line treatment for hypercholesterolemia 2, 3.
- Ezetimibe: can be added to statin therapy to achieve LDL-C targets, with a further reduction of 20% in LDL-C levels 2, 4.
- PCSK9 inhibitors: can reduce LDL-C levels by 50% or greater when added to statin therapy, with a well-established safety and tolerability record 2, 5.
- Bempedoic acid: a recently approved treatment that is well tolerated and appears to be free of skeletal muscle-related problems, but the cardiovascular outcome study has not been completed 2.
- Physical activity: recommended as a critical component of first-line treatment for elevated blood pressure or cholesterol, with benefits comparable to other healthy lifestyle changes 6.
Patient Groups
- High-risk patients: include those with ASCVD, severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for ASCVD of 20% or greater 5.
- Mild-moderate-risk patients: can be treated with lifestyle-only approaches, including physical activity, as first-line therapy for elevated blood pressure or cholesterol 6.