LMCC/Dyslipidemia

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  • abnormal elevation of plasma cholesterol or triglycerides
  • this disorder increases the risks associated with obesity, diabetes and alcohol use

Assessment[edit]

Signs of Hyperlipidemia[edit]

  • atheromata - plaques in blood vessel walls
  • xanthoma - plaques or nodules composed of lipid laden histiocystes in the skin and eyelids
  • tendinous xanthoma - lipid deposits in tendons
  • corneal arcus (arcus senillis) - lipid deposits in corena
  • levels should be measured every five years in those > age 20
  • prior to labs, also assess for coronary artery disease risk factors
  • labs drawn are:
    • total cholesterol
    • LDL-C (bad cholesterol)
      • Note: LDL-C cannot be calculated if triglyceride levels are >4.5mmol/L
    • HDL-C (good cholesterol)
    • triglyceride levels

Risk Category[edit]

Emerging risk factors for hypertriglyceridemia[edit]


  • must also estimate 10 year risk for developing coronary artery disease using the Framingham heart data

Risk Factors for CAD[edit]

Major

1. Smoking

2. Diabetes

3. Hypertension

4. Hyperlipidemia

5. Family History of CAD

Minor

1. Obesity

2. Sedentary lifestyle

3. Hyperhomoysteinemia

Target Lipid Values for Primary Prevention of CAD[edit]

  • once risk is established, target levels can be set
Risk Category LDL-C(mmol/L) Total-cholesterol:HDL-C ratio
High

10 year risk of CAD > 20%/history of DM/history of atherosclerotic disease

<2.5 <4
Moderate

10 year risk 11%-19%

<3.5 <5
Low

10 year risk < 10%

<4.5 <6
  • note: There are no longer any target triglyceride levels

Management[edit]

  • use risk level as a guide for treatment
  • use dietary/lifestyle modification for 3 months before initiating drug therapy:
    • weight loss
    • exercise
    • avoid EtOH and smoking
    • blood glucose control
    • increase omega-3 fatty acid intake
  • after the initiation of drug therapy, lipids should be measured after 6 weeks and 3 months.
    • if adequate reevaluate in 6 months
    • monitor ALT, AST and CK every 6 months for signs of transaminitis or myositis, a potential side effect of using lipid lowering agents.

Pharmacology: Lipid Lowering Agents[edit]

  • statins: HMG-CoA reductase inhibitors
    • Atorastatin (Lipitor)
    • Lovostatin (Mevacor)
    • Pravastatin (Pravachol)
    • Simvastatin (Zocor)
    • Rosuvastatin (Crestor)
  • bile acid sequestrants
  • nicotinic acid
  • fibrates
  • psyllium
  • cholesterol absorption inhibitors (ie. ezetimibe)

Isolated hypertriglyceridemia[edit]

  • normal HDL-C and total cholesterol with elevated triglycerides
    • mild: TG > 2.0mmol/L
    • marked: TG > 4.5mmol/L
  • principal therapy is lifestyle modification
  • drug therapy is nicotinic acid or fibrates

References[edit]

Toronto Notes 2005

Additional Reading[edit]

Statin use in treating high cholesterol