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H y perlipidaemi á k

H y perlipidaemi á k. Szollár Lajos Klinikai kórélettan 2006. Szeptember 28. Metabolic pathways for endogenous and exogenous lipids. The path of normal lipid metabolism. ABCA1. Reverse Cholesterol Transport. Reverse cholesterol transport. Cell. SRB1. Liver. membrane. LDL. receptor.

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H y perlipidaemi á k

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  1. Hyperlipidaemiák Szollár Lajos Klinikai kórélettan 2006. Szeptember 28.

  2. Metabolic pathways for endogenous and exogenous lipids

  3. The path of normal lipid metabolism

  4. ABCA1 Reverse Cholesterol Transport Reverse cholesterol transport Cell SRB1 Liver membrane LDL receptor CE CE FC VLDL, IDL, LDL LCAT CETP HDL HDL3 TG Peripheral tissues Free cholesterol FC TG Triglycerides CE Cholesteryl esters LCAT Lecithin cholesterol acyltransferase CETP Cholesteryl ester transfer protein

  5. HDL metabolism and reverse cholesterol transport

  6. Regulation of cholesterol biosynthesis

  7. LDL receptor structure-function relationship

  8. A Utah pedigree with familial hypercholestolaemia

  9. Prevalence of tendon xanthomas and full circumference corneal arcus in 354 Utah patients

  10. Factors altering the course of cardiovascular disease

  11. NCEP ATP III Guidelines (2004 proposed modifications) Initiate TLC* Drug therapy LDL-C goal Patients with if LDL-C considered if LDL-C High risk: CHD or CHD risk equivalents (10-year risk >20%) <100 mg/dL† (optional goal: <70 mg/dL†) 100 mg/dL (<100 mg/dL: drug optional) 100 mg/dL† Moderately high risk: >2 risk factors (10-year risk 10-20%) 130 mg/dL (100-129 mg/dL: drug optional) <130 mg/dL† (optional goal: <100 mg/dL†) 130 mg/dL† Moderate risk: >2 risk factors (10-year risk <10%) <130 mg/dL† 130 mg/dL† 160 mg/dL† <160 mg/dL† 160 mg/dL† 190 mg/dL† (160-189 mg/dL: drug optional) Lower risk: 0-1 risk factors †70 mg/dL = 1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L; 190 mg/dL = 5 mmol/L: * TLC: therapeutic lifestyle changes Grundy SM et al. Circulation 2004;110:227-239.

  12. Lower Risk < 2 risk factors Target 130 mg/dL Target 100 mg/dL or optional 70 mg/dL* or optional 100 mg/dL** NCEP ATP III: LDL-C Goals(2004 proposedmodifications) Moderately High Risk ≥ 2 risk factors (10-yr risk 10-20%) Moderate Risk ≥ 2 risk factors (10-yr risk <10%) High Risk CHD or CHD risk equivalents (10-yr risk >20%) 190 - Target 160 mg/dL 160 - Target 130 mg/dL LDL-C level 130 - 100 - 70 - *Therapeutic option in very high-risk patients and in patients with high TG, non-HDL-C<100 mg/dL; ** Therapeutic option; 70 mg/dL =1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L Grundy SM et al. Circulation 2004;110:227-239.

  13. LDL-koleszterin- szint egy nyugat-európai népességben:, fiziológiás tartomány és terápiás célok. Népesség frekvencia Célértékek Fiziológiás tartomány LDL-cholesterin mmol/L 0.5 1.5 3.0 2.5 1.8 Adapted from: O. Faergeman, S. M. Grundy. Dyslipidaemia. Elsevier. 2003

  14. Impact of Recent Clinical Trials: Revised CAD Risk Categories

  15. Estimate total CVD risk of fatal CVD event in 10 years using SCORE chart Total CVD risk <5% TC 5 mmol/L (190 mg/dL) Total CVD risk 5% TC 5 mmol/L (190 mg/dL) Measure fasting lipids, give lifestyle advice, with repeat lipids after 3 months Lifestyle advice Aim: TC<5 mmol/L (190 mg/dL) LDL-C <3.0 mmol/L (115 mg/dL) Follow-up at 5-year intervals TC 5 mmol/L (190 mg/dL) or LDL-C 3 mmol/L (115 mg/dL) Maintain lifestyle advice and start drug therapy TC <5 mmol/L (190 mg/dL) and LDL-C <3.0 mmol/L (115 mg/dL) Maintain lifestyle advice with annual follow-up. If total risk remains 5%, consider drugs to lower TC to <4.5 mmol/L (175 mg/dL) and LDL-C to <2.5 mmol/L (100 mg/dL) 2003 European Guidelines:Guide to lipid management in asymptomatic subjects De Backer G et al. Eur Heart J 2003;24:1601–1610.

  16. 3rd European Guidelines Goals - Risk factors: • Prophylactic drug therapy should be considered in particular groups. These parameters have been summarized as a mnemonic for the practitioner as the "European heart health telephone number": 14090530 • 140 mm Hg SBP • 90 mm Hg DBP • 5 mmol/L (150 mg/dL) total cholesterol • 3 mmol/L (115 mg/dL) LDL cholesterol • 0 NO SMOKING

  17. Risk estimation is based on age, sex, smoking habits, systolic blood pressure (SBP), and either total cholesterol or cholesterol/HDL ratio.[7] Using the SCORE model, risk charts can be provided for all European countries. Total risk can be calculated from SCORE charts The low-risk chart is for countries such as Belgium. France, Greece, Italy, Luxembourg, Portugal, Spain, and Switzerland. Relative risk is calculated by comparing an individual's risk category with that of a nonsmoking person of the same age and gender with blood pressure </= 140/90 mm Hg and total cholesterol < 5 mmol/L (< 190 mg/dL).

  18. Risk estimation is based on age, sex, smoking habits, systolic blood pressure (SBP), and either total cholesterol or cholesterol/HDL ratio.[7] Using the SCORE model, risk charts can be provided for all European countries. Total risk can be calculated from SCORE charts. The high-risk chart is for use in all other European countries. Relative risk is calculated by comparing an individual's risk category with that of a nonsmoking person of the same age and gender with blood pressure </= 140/90 mm Hg and total cholesterol < 5 mmol/L (< 190 mg/dL).

  19. II. Magyar Terápiás Konszenzus Ajánlása kardiovaszkuláris betegségekmegelőzéséről és preventív kezelésérőlHáziorvos Továbbképzô Szemle 2006; 11: 131–138

  20. II. Magyar Terápiás Konszenzus Ajánlása kardiovaszkuláris betegségekmegelőzéséről és preventív kezelésérőlHáziorvos Továbbképzô Szemle 2006; 11: 131–138

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