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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