Skip to Main Content
Home Books Internal Medicine: A Guide to Clinical Therapeutics

Chapter 6. Lipid Disorders

Elizabeth M. Urteaga

  • Sections
  • Print
  • Get Citation

    Citation

    AMA Citation
    Urteaga EM. Urteaga E.M. Urteaga, Elizabeth M.Chapter 6. Lipid Disorders. In: Attridge RL, Miller ML, Moote R, Ryan L. Attridge R.L., Miller M.L., Moote R, Ryan L Eds. Rebecca L. Attridge, et al.eds. Internal Medicine: A Guide to Clinical Therapeutics New York, NY: McGraw-Hill; 2013. http://accesspharmacy.mhmedical.com/content.aspx?bookid=565&sectionid=42003713. Accessed November 20, 2019.
    MLA Citation
    Urteaga EM. Urteaga E.M. Urteaga, Elizabeth M.. "Chapter 6. Lipid Disorders." Internal Medicine: A Guide to Clinical Therapeutics Attridge RL, Miller ML, Moote R, Ryan L. Attridge R.L., Miller M.L., Moote R, Ryan L Eds. Rebecca L. Attridge, et al. New York, NY: McGraw-Hill, 2013, http://accesspharmacy.mhmedical.com/content.aspx?bookid=565&sectionid=42003713.

    Download citation file:

    RIS (Zotero)
    EndNote
    BibTex
    Medlars
    ProCite
    RefWorks
    Reference Manager
    Mendeley
    © Copyright
  • Tools
  • Search Book
  • Clip
Top

  • Lipoproteins transport hydrophobic lipids (primarily triglycerides & cholesterol) through body fluids
  • 5 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 measurement
  • NCEP 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 Framingham
  • Rule out secondary causes of dyslipidemia

Favorite Table | Download (.pdf) | Print
Clinical Pearl 6-1

TC & HDL remain the same fasting & non-fasting

Table 6-1 Evaluation of Lipid Profile
View Table|Favorite Table|Download (.pdf)
Table 6-1 Evaluation of Lipid Profile

LDL Cholesterol (LDL = TC-HDL – [TG/5] if TG <400)

Fasting (12h) Lipid Panel

Value (mg/dL)

Optimal

<100

Near or above optimal

100–129

Borderline high

130–159

High

160–189

Very high

≥190

Total Cholesterol

Desirable

<200

Borderline high

200–239

High

≥240

HDL Cholesterol

Low

<40

High

≥60

Triglycerides

Normal

<150

Borderline high

150–199

High

200–499

Very high

≥500

Table 6-2 LDL Cholesterol Goals & Cutpoints for Therapeutic Lifestyle Changes & Drug Therapy in Different Risk Categories
View Table|Favorite Table|Download (.pdf)
Table 6-2 LDL Cholesterol Goals & Cutpoints for Therapeutic Lifestyle Changes & Drug Therapy in Different Risk Categories

Risk Category

LDL 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

≥160

Lower risk: 0–1 risk factor

<160

≥160

≥190

(160–189: LDL-lowering drug optional)

Table 6-3 Secondary Causes of Dyslipidemia
View Table|Favorite Table|Download (.pdf)
Table 6-3 Secondary Causes of Dyslipidemia

Secondary Cause

Lipid Changes

End-stage renal disease

↑ triglycerides, ↓ HDL

Nephrotic syndrome

↑ VLDL & triglycerides

Hypothyroidism

↑ LDL & triglycerides

Drugs: glucocorticoids, anabolic steroids, estrogens & progestins, tamoxifen, protease inhibitors, diuretics, β-blockers, bile acid resins, isotretinoin, mirtazapine, sirolimus

Variable effects

Cigarette use

↓ HDL

Diabetes mellitus

↑ triglycerides, ↓ HDL

Excessive alcohol consumption

↑ triglycerides

Obstructive liver disease

↑ LDL

Pregnancy

↑ LDL & triglycerides

Anorexia

↑ LDL

Caloric excess or diet high in saturated fat

↑ LDL

Sedentary lifestyle

↓ HDL

Adapted from Ross LA, Ross BS, East H. Dyslipidemia. In: Linn W, Wofford M, O'Keefe ME, Posey LM (eds). Pharmacotherapy in Primary Care. New York: McGraw-Hill, 2009.

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close