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KEY POINTS

KEY POINTS

  • Lowering low-density cholesterol to target levels is no longer the primary goal of treatment.

  • Patients with dyslipidemia as well as other diseases that put them at risk for atherosclerotic cardiovascular disease should be assessed for the need for treatment.

  • Statins are the preferred medications for atherosclerotic cardiovascular disease risk reduction.

  • Lifestyle modifications such as a low-fat diet and exercise should be instituted, along with medication for maximal treatment effect.

  • Medication therapy management (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.

INTRODUCTION TO DYSLIPIDEMIA

Cholesterol is a fat-like substance (lipid) 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 proteins (lipoproteins). The three major classes of lipoproteins are 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 may be defined as an elevation in total cholesterol (TC), LDL cholesterol, or triglycerides, 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.1 Other studies have also suggested that low levels of HDL also correspond with an increased risk of cardiovascular disease.

Other Terms Associated with Dyslipidemia

  • Familial hypercholesterolemia1 - This term is used for individuals that meet the following three criteria:

    • High TC, TG usually normal

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

    • Hypercholesterolemia caused by an inherited autosomal trait

  • Hyperlipidemia1 - 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.

  • Hypertriglyceridemia1,2 - A state in which the TG levels are elevated. This can occur alone, or in conjunction with other lipid abnormalities.

  • Primary prevention2 - Treatment of dyslipidemia to prevent or delay the onset of atherosclerotic cardiovascular disease (ASCVD).

  • Secondary prevention2 - Treatment of dyslipidemia to prevent progression of ASCVD or recurrent ASCVD events.

Dyslipidemia is detected through a fasting lipoprotein profile including TC, LDL cholesterol, HDL cholesterol, and triglycerides. All adults aged ≥20 years should have a fasting lipoprotein profile measured at least every 4 to 6 years according to the American Heart Association (AHA).2 Individuals should fast for at least 8 to 12 hours before getting blood drawn. If the lipid profile is obtained in the nonfasting state, only total cholesterol and HDL cholesterol will be valid. This ...

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