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Source: Talbert RL. Dyslipidemia.
In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=7974214.
Accessed July 6, 2012.
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- Hyperlipidemia
- Hypercholesterolemia
- Hyperlipoproteinemia
- Lipid disorders
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- Elevated total cholesterol, low-density lipoprotein cholesterol
(LDL-C), or triglycerides (TG); a low high-density lipoprotein cholesterol
(HDL-C); or a combination of these abnormalities.
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- Genetic abnormalities
- Hypothyroidism
- Liver disease
- Nephrotic syndrome
- Cushing’s disease
- Drugs
- Progestins
- Thiazide diuretics
- Glucocorticoids
- β-blockers
- Isotretinoin
- Protease inhibitors
- Cyclosporine
- Sirolimus
- Mirtazapine
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- Oxidized LDL, injury to vascular endothelium, excessive
homocysteine, immunologic attack, and infection-induced changes
lead to atherosclerosis.
- Repeated plaque injury and repair lead to fibrous cap protecting
underlying core; plaque rupture results in coronary thrombosis.
- Primary or genetic lipoprotein disorders:
- I
(chylomicrons)
- IIa (LDL)
- IIb (LDL + very-low-density lipoprotein [VLDL])
- III (intermediate-density lipoprotein)
- IV (VLDL)
- V (VLDL + chylomicrons)
- Clinical outcomes may include:
- Angina
- Myocardial infarction (MI)
- Arrhythmias
- Stroke
- Peripheral arterial disease
- Abdominal aortic aneurysm
- Sudden death
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- 46.8% or 10.2 million American adults over age
20 years have total cholesterol levels of ⩾200
mg/dL.
- Established coronary heart disease (CHD) or prior MI increases
risk of MI 5–7 times that of men or women without CHD.
- About 50% of all MIs and at least 70% of
CHD deaths occur in patients with known CHD.
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- Measure fasting lipid profile (FLP) including total cholesterol,
LDL, HDL, and triglycerides in all adults 20 years of age or older
at least once every 5 years.
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- Obesity
- Sedentary lifestyle
- Diabetes mellitus
- Alcohol use
- Hypothyroidism
- Nephrotic syndrome
- Chronic kidney disease
- Liver disease
- Cushing’s disease
- Certain medications (see Etiology)
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- Symptoms range from none to:
- Chest pain
- Palpitations
- Sweating
- Anxiety
- Shortness of breath
- Loss of consciousness or difficulty with speech or movement
- Abdominal pain
- Sudden death
- Signs range from none to:
- Abdominal pain
- Pancreatitis
- Eruptive xanthomas
- Peripheral polyneuropathy
- High blood pressure
- Body mass index >30 kg/m2 or waist size
>40 inches in men (35 inches in women)
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Means of Confirmation
and Diagnosis
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- After confirming a lipid abnormality,
perform medical history, physical examination, and laboratory tests.
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- Fasting lipid profile elevations in total cholesterol,
LDL-C, triglycerides, apolipoprotein B, and C-reactive protein (CRP);
low HDL-C.
- Lipoprotein (a) and small, dense LDL (pattern B), HDL-C subclassification,
apolipoprotein E isoforms, apolipoprotein A-1, fibrinogen, folate,
lipoprotein-associated phospholipase A2.
- Screening tests for diabetes: Fasting glucose, oral glucose
tolerance test, A1C.
- Serum thyroid-stimulating hormone (TSH) to screen for hypothyroidism.
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Diagnostic Procedures
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- Screening tests for vascular disease: Ankle-brachial index,
exercise testing, magnetic resonance imaging.
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Differential
Diagnosis
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++
- Lower total and LDL cholesterol to reduce risk of first
or recurrent cardiovascular events.
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- Major Risk Factors for CHD (excluding LDL-C)
- Age:
Men 45 years and older; women 55 years and ...