Dyslipidemia

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Diagnosis and Treatment of Dyslipidemia : 

Diagnosis and Treatment of Dyslipidemia New guidelines are based on the “Adult Treatment Plan III (ATP III)” 2004 Focus = multiple risk factor assessment to determine those individuals at highest absolute Coronary Heart Disease (CHD) risk Diabetes is identified as being a CHD risk equivalent - in other words, a person with Diabetes is considered at the same risk of CHD as a person with a previous hx of CHD

Assessing CHD Risk : 

Assessing CHD Risk Framingham Risk Score - Projects potential for 10 year absolute CHD Risk (ranges from < 10% to > 20%) Use in patients without CHD or CHD Risk Equivalents

Lipid Evaluation : 

Lipid Evaluation Done after a 9 – 12 hour fast to ensure an adequate evaluation of all components of a lipid profile If Triglycerides are extremely elevated, calculation of the LDL can be difficult Non-fasting samples should not be used for diagnosis

LDL Goals : 

LDL Goals

Medications for Treatment of Dyslipidemia : 

Medications for Treatment of Dyslipidemia New Recommendations in Therapeutics - Combination therapy is recommended for selected high risk patients - Despite success of the statins as a group, coronary event rates remain high - Combination therapy may be as efficacious as single therapy with less side effects - Side effects and toxicity of statins increase with each dosage increment

Types of Medications : 

Types of Medications Drugs that Affect Hepatic Lipoprotein Metabolism 1) HMG-CoA Reductase Inhibitors (statins) - Lovastatin, pravastatin, simvastatin, fluvastatin 2) Nicotinic Acid - Immediate release (IR), sustained release (SR), extended release (ER) 3) Fibrates - Gemfibrozil, fenofibrate, clofibrate

Types of Medications : 

Types of Medications Drugs that Affect Intestinal Metabolism of Cholesterol 1) Bile Acid Sequestrants - Cholestyramine, colestipon, colesevelam 2) Inhibitors of cholesterol absorption (vegetable derived) - Sterol/stanol esters (available in dietary margarine – BeneChol®) 3) Selective Cholesterol Absorption Inhibitor (CAI) - Ezetimibe  NEW CLASS

Lifestyle Treatment of Dyslipidemia : 

Lifestyle Treatment of Dyslipidemia Lifestyle Changes Still Recommended for all patients Physical Activity Smoking cessation Weight Loss Dietary modification Reduce saturated and “trans” fats Increase fiber (25g/day) Consider plant sterols/stanols (2-3 servings/day)

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