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DYSLIPIDEMIA

DYSLIPIDEMIA. Ruth P. Anglo, MD Department of Family & Community Medicine May 5,2012. Step 1: Determine and classify lipoprotein levels ATP Classification of LDL, Total, and HDL Cholesterol. Step 2 : Identify presence of clinical atherosclerotic disease Clinical CHD

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DYSLIPIDEMIA

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  1. DYSLIPIDEMIA Ruth P. Anglo, MD Department of Family & Community Medicine May 5,2012

  2. Step 1: Determine and classify lipoprotein levels ATP Classification of LDL, Total, and HDL Cholesterol

  3. Step 2: Identify presence of clinical atherosclerotic disease • Clinical CHD • Symptomatic coronary artery disease • Peripheral artery disease • Abdominal aortic aneurysm

  4. Step 3: Major Risk Factors • Cigarette smoking • Hypertension • Low HDL cholesterol (<40 mg/dL) • Family history of premature CHD male: <55 years; female: <65 years • Age: men >/=45 years; • women >/= 55 years

  5. Step 4: Determine risk category

  6. Therapeutic Lifestyle Changes • Weight management • Increase physical activity • TLC diet • - Saturated fat < 7% of calories • Cholesterol < 200 mg/dL • Fiber 10-25 g/day

  7. Model of Steps in Therapeutic Lifestyle Changes Visit 1: Begin lifestyle therapies 6 weeks Visit 2: Evaluate LDL response If goal not reached,intensify LDL-lowering therapy 6 weeks

  8. Visit 3: Evaluate LDL response If LDL goal not reached, consider adding drug therapy Q 4-6 weeks Visit N: Monitor adherence to TLC

  9. Progression of Drug Therapy in Primary Prevention Initiate LDL-lowering therapy 6 weeks If LDL goal not achieved,intensify LDL-lowering therapy 6 weeks

  10. If LDL goal not reached, intensify drug therapy Q 4-6 mos Monitor response and adherence to therapy

  11. Drugs Affecting Drug Metabolism Statins LDL 18-55% decrease HDL 5-15% increase TG 7-30% decrease S/E: Increased liver enzymes, myopathy CI: Active or chronic liver disease

  12. Fibric Acids Gemfibrozil, Clofibrate, Fenofibrate LDL 5-20% decrease HDL 10-20% increase TG 20-50% decrease SE: Dyspepsia, gallstones, myopathy CI: severe renal disease, severe hepatic dse

  13. Bile Acid Sequestrants Cholestyramine, Colestipol LDL 15-30% decrrease HDL 3-5% increase TG no change or increase SE: GI distress, constipation CI: Dysbetalipoprotenemia, TG >200/>400 mg/dL

  14. Nicotinic Acid LDL 5-25% decrease HDL 15-35% increase TG 20-50% decrease SE: Flushing, hyperglycemia, hyperuricemia upper GI distress, hepatotoxicity CI: Chronic liver dse, severe gout DM, hyperuricemia, PUD

  15. Identify metabolic syndrome and treat, if present after 3 months of TLC:

  16. Treatment of Metabolic Syndrome Treat underlying causes -Intensify weight management -Increase physical activity Treat lipid & non-lipid risk factors -Treat hypertension -Use ASA for CHD patients -Treat elevated TG and/or low HDL

  17. Treat elevated triglycerides: ATP III Classification of Serum TG (mg/dL)

  18. Treatment of elevated triglycerides (>/= 150mg/dL) • Primary aim of therapy is to reach LDL goal • Intensify weight management • Increase physical activity • If TG is >/=200mg/dL after LDL goal is reached,set secondary goal for non-HDL cholesterol 30mg/dL higher than LDL cholesterol

  19. Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals

  20. Treatment of Low HDL Cholesterol • (40 mg/dL) • Reach LDL goal • Intensify weight management and increase physical activity • If TG 200-499 mg/dL,achieve non-HDL goal • If TG < 200 mg/dL in CHD or CHD equivalent consider nicotinic acid or fibrate

  21. Thank you!

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