Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Lipoproteins transport hydrophobic lipids (primarily triglycerides & cholesterol) through body fluids5 classes of lipoproteins based on size & density: chylomicrons, very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL) ++ Pertinent evaluation: lipid profile (dyslipidemia = elevated TC, LDL, TG, &/or reduced HDL); if TG >400mg/dL, perform direct LDL measurementNCEP ATP III guidelines recommend fasting lipid panel beginning at age 20y; if normal, repeat every 5y, or earlier if coronary heart disease (CHD) risk increases Classify patient by risk (Framingham risk calculator) to guide & determine aggressiveness of treatment Risk factors for CHD: cigarette smoking, HTN (BP ≥140/90mmHg or on antihypertensive), HDL <40mg/dL, CV event in 1st-degree male relative <55 yo, or female <65 yo at time of event, age ≥45 men, ≥55 women; HDL ≥60mg/dL is a negative risk factor (subtract 1 RF)CHD risk equivalents: DM, aortic aneurysm, peripheral vascular disease, carotid artery disease (TIA, stroke), 10-y risk >20% for CHD based on FraminghamRule out secondary causes of dyslipidemia ++Table Graphic Jump LocationFavorite Table | Download (.pdf) | PrintClinical Pearl 6-1TC & HDL remain the same fasting & non-fasting ++Table Graphic Jump LocationTable 6-1 Evaluation of Lipid ProfileView Table|Favorite Table|Download (.pdf)Table 6-1 Evaluation of Lipid ProfileLDL Cholesterol (LDL = TC-HDL – [TG/5] if TG <400)Fasting (12h) Lipid PanelValue (mg/dL)Optimal<100Near or above optimal100–129Borderline high130–159High160–189Very high≥190Total CholesterolDesirable<200Borderline high200–239High≥240HDL CholesterolLow<40High≥60TriglyceridesNormal<150Borderline high150–199High200–499Very high≥500 ++Table Graphic Jump LocationTable 6-2 LDL Cholesterol Goals & Cutpoints for Therapeutic Lifestyle Changes & Drug Therapy in Different Risk CategoriesView Table|Favorite Table|Download (.pdf)Table 6-2 LDL Cholesterol Goals & Cutpoints for Therapeutic Lifestyle Changes & Drug Therapy in Different Risk CategoriesRisk CategoryLDL Goal (mg/dL)LDL Level to Initiate TLC (mg/dL)LDL Level to Consider Drug Therapy (mg/dL)High risk: CHD or CHD risk equivalents (10-y risk >20%)<100 (optional goal: <70)≥100≥100(<100mg/dL; consider drug options)Moderately high risk: 2+ risk factors (10-y risk >10–20%)<130≥130≥130(100–129: consider drug options)Moderate risk: 2+ risk factors (10-y risk <10%)<130≥130≥160Lower risk: 0–1 risk factor<160≥160≥190(160–189: LDL-lowering drug optional) ++Table Graphic Jump LocationTable 6-3 Secondary Causes of DyslipidemiaView Table|Favorite Table|Download (.pdf)Table 6-3 Secondary Causes of DyslipidemiaSecondary CauseLipid ChangesEnd-stage renal disease↑ triglycerides, ↓ HDLNephrotic syndrome↑ VLDL & triglyceridesHypothyroidism↑ LDL & triglyceridesDrugs: glucocorticoids, anabolic steroids, estrogens & progestins, tamoxifen, protease inhibitors, diuretics, β-blockers, bile acid resins, isotretinoin, mirtazapine, sirolimusVariable effectsCigarette use↓ HDLDiabetes mellitus↑ triglycerides, ↓ HDLExcessive alcohol consumption↑ triglyceridesObstructive liver disease↑ LDLPregnancy↑ LDL ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options