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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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Signs and Symptoms

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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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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 older or premature menopause without estrogen ...

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