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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 8, Dyslipidemia.
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KEY CONCEPTS
Lipid abnormalities increase the risk for coronary heart disease (CHD) and cerebrovascular morbidity and mortality.
Low-density-lipoprotein cholesterol (LDL-C) is the primary target for lipid-lowering therapy.
Genetic abnormalities and environmental factors are involved in the development of dyslipidemia.
Therapeutic lifestyle change is first-line therapy for any lipoprotein disorder.
If therapeutic lifestyle changes are insufficient, lipid-lowering agents should be chosen based on which lipid is at an undesirable level and the degree to which it is expected to increase the risk of atherosclerotic cardiovascular disease (ASCVD).
Statins are the drugs of choice for dyslipidemia because of potency and cost-effectiveness.
If statin monotherapy is insufficient, patients may be treated with evidence-based combination therapy but should be monitored closely for drug–drug interactions.
Reducing total cholesterol and LDL-C reduces CHD and total mortality.
Lipid-lowering therapies that reduce ASCVD event rates are cost-effective.
Several novel medications including antisense oligonucleotide inhibitors of apoB, microsomal triglyceride transport protein inhibitors, adenosine triphosphate-citrate lyase (ACL) inhibitors, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can be used as add-on therapy or in lieu of statin therapy in select high-risk populations.
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Preclass Engaged Learning Activity
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Cholesterol, triglycerides, and phospholipids are the major lipids that combine with proteins to be transported as complexes of lipid and proteins known as lipoproteins. Lipids, such as cholesterol and triglycerides, are insoluble in plasma, which is why the lipoproteins are required for transportation (Fig. 31-1).1,2
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There are three major classes of lipoproteins in the ...