Hyperlipidemia
Evaluation
General—a significant contributor to atherosclerosis and consequently coronary heart disease (CHD)
Low-density lipoprotein (LDL) is a primary mediator of atherosclerosis.
Epidemiology—CHD accounts for 500,000 deaths per year in the United States (no.1 cause of morbidity and mortality)
Screening—fasting lipid profile (total cholesterol, LDL, high-density lipoprotein [HDL], and triglycerides [TG]) q5yr for patients of age 20 years or older.
Risk factors impacting LDL goals
Age (men of age 45 years or older, women of age 55 years or older)
HDL <A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<40 mg per dL
Smoking
Hypertension (blood pressure [BP] ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b75d2129a25d01f3042ff2fa0b188b440}/ID(AB1-M10)”>>140/90 or patient is taking antihypertensives)
Family history of premature CHD (first degree male younger than 55 years, first degree female younger than 65 years)
CHD risk equivalents
Diabetes
Risk stratification and assessment (see Table 2.35.1)
Treatment—may try therapeutic lifestyle changes (TLC) for 12 weeks before considering medications.
TLC
Diet—low in saturated fat and trans fatty acids; cholesterol <A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<200 mg per day
Weight loss—decreases LDL and improves insulin sensitivity
No smoking—increases HDL
Medications (initially check lipid profile and liver function tests (LFTs) every 6 weeks, then q6mo to every 12 months when LDL is normal)
Note: Watch for myalgias and rhabdomyolysis with statins.
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