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KEY POINTS

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  • Lowering LDL cholesterol levels is the primary goal of treatment for the majority of patients.

  • Patients with dyslipidemia should be assessed for coronary heart disease (CHD) risk factors and CHD risk equivalents in order to establish the appropriate LDL goal.

  • Patients should adopt lifestyle modifications, such as a low-fat diet and regular exercise, along with medication for maximal treatment effect.

  • MTM providers should emphasize the importance of adherence to medications and the timing of administration to optimize efficacy.

  • MTM providers should educate patients regarding the serious adverse effects of cholesterol medications and when to contact the prescriber or seek medical assistance.

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INTRODUCTION TO DYSLIPIDEMIA

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Cholesterol is a lipid or fat-like substance that is present in cell membranes and is a precursor of bile acids and steroid hormones. Cholesterol travels in the blood in distinct particles containing both lipid and lipoproteins. There are 3 major classes of lipoproteins: low-density lipoproteins (LDL), high-density lipoproteins (HDL), and very low-density lipoproteins (VLDL).1 A major component of VLDL is triglycerides (TG), a storage form of fat. Dyslipidemia can be defined as an elevation in total cholesterol (TC), LDL cholesterol, or TG, a low level of HDL cholesterol, or any combination of these abnormalities. Dyslipidemias, particularly those characterized by elevations in LDL cholesterol, are associated with an increased risk of coronary heart disease (CHD), cerebrovascular disease, and peripheral arterial disease.2

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Other Terms Associated with Dyslipidemia

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  • Familial hypercholesterolemia2—term used for individuals that meet the following 3 criteria:

    • High TC (TG usually normal)

    • Deposition of LDL-derived cholesterol in tendons and arteries (xanthomas, atheromas)

    • Hypercholesterolemia caused by an inherited autosomal trait

  • Hyperlipidemia—describes cholesterol abnormalities and simply refers to elevated lipid levels. Dyslipidemia and hyperlipidemia, along with hypercholesterolemia, are often used interchangeably to describe elevated cholesterol levels, even though they each have a unique meaning.

  • Hypertriglyceridemia—state in which the TG levels are elevated; can occur alone or in conjunction with other lipid abnormalities

  • Primary prevention—treatment of dyslipidemia to prevent or delay the onset of cardiovascular disease

  • Secondary prevention—treatment of dyslipidemia to prevent progression of cardiovascular disease or recurrent cardiovascular events

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Dyslipidemia is detected through a fasting lipoprotein profile including TC, LDL cholesterol, HDL cholesterol, and TGs. All adults 20 years of age and older should have a fasting lipoprotein profile measured at least every 5 years. Individuals should fast for at least 9 to 12 hours before getting blood drawn.1 If the lipid profile is obtained in the nonfasting state only total cholesterol and HDL cholesterol will be valid. This is because TGs are elevated in the non-fasting state, and the LDL cholesterol is usually a calculated value that will be inaccurate if the TGs are inflated. If the total cholesterol is 200 mg/dL or greater or if HDL cholesterol is less than 40 mg/dL, a follow-up fasting lipoprotein file should be obtained.2 Classifications ...

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