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  • 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

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Clinical Pearl 6-1

TC & HDL remain the same fasting & non-fasting

Table 6-1 Evaluation of Lipid Profile
Table 6-2 LDL Cholesterol Goals & Cutpoints for Therapeutic Lifestyle Changes & Drug Therapy in Different Risk Categories
Table 6-3 Secondary Causes of Dyslipidemia

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