dyslipidemia

Question 1

Dyslipidemia

Dyslipidemia age and gender

Answer 1

> 45 for males

>55 for females

Question 2

Dyslipidemia

Risk factors for dyslipidemia

Answer 2

• sedentary lifestyle, diet high in saturated and trans fats
• obesity, metabolic syndrome, diabetes, HTN
• smoking

Question 3

Dyslipidemia

What are the 2 major lipids and 5 major lipoproteins?

Answer 3

Lipids: cholesterol and lipids

Lipoproteins: chylomicrons, VLDL, IDL, LDL, HDL

Hint*
High Class In Las Vegas (HDL, Chylo, IDL, LDL, VLDL)

Question 4

Dyslipidemia

What percentage of total serum cholesterol is HDL?

Answer 4

25%

Question 5

Dyslipidemia

What percentage of total serum cholesterol is LDL?

Answer 5

70%

Question 6

Dyslipidemia

What do VLDL do?

Answer 6

carry triglycerides from liver

Question 7

Dyslipidemia

What is cholesterol made from?

Answer 7

HDL, LDL, VLDL

Question 8

Dyslipidemia

What is lipoprotein (a)

Answer 8

apoB + apo A = Lp(a)

controlled by a single gene (chromosome 6)

not influenced by age, sex, fasting, inflammation, lifestyle

stable. measure once in a lifetime.

Question 9

Dyslipidemia

What is primary dyslipidemia, secondary dyslipidemia, and hyperlipidemia?

Answer 9

Primary = genetic 
Secondary = acquired 

hyper = high 
dys = abnormal

Question 10

Dyslipidemia

PE for dyslipidemia

Answer 10

Ht and wt (for BMI), waist circumference
BP
CVS and PVS
Abdo: hepatosplenomegaly
Derm: xanthomas (lipid deposits from high VLDL): xanthelasma (eyelids), tendinous xanthomas (Achilles, tendons, patellae, hands)
Eyes: corneal arcus in pts <40

Question 11

Dyslipidemia

FRS (Low, medium, high risk), age

Answer 11

FRS < 10 low risk
FRS 10-19.9 medium risk
FRS > 19.9 high risk
*74 yrs

Question 12

Dyslipidemia

Who to screen for dyslipidemia

Answer 12

• > 40 years or postmenopausal
• clinical evidence of atherosclerosis
• AAA
• DM
• HTN
• smoking
• xanthelasma, xanthoma, arcus cornea
• fmhx premature CVD
• fmhx dyslipidemia
• obesity
• CKD
• inflammatory disease
• HIV
• ED
• COPD
• PIH

Question 13

Dyslipidemia

what are statin-indicated conditions?

Answer 13

• artherosclerosis
• AAA
• T2DM > 40 yoa or T1DM > 30 yoa X 15 yr duration
• CKD
• LDL> 5 (genetic)

Question 14

Dyslipidemia

primary prevention indications for statins

Answer 14

FRS > 10
PLUS
LDL > 3.5 or non-HDL > 4.3 or apoB > 1.2, or male > 50/female > 60 w/ one additional risk factor
–> statin

FRS > 20 –> statin

Question 15

Dyslipidemia

How to screen

Answer 15

history and physical examination

standard lipid profile: TC, LDL-C, HDL-C, non-HDL-C*, TG

FPG or A1c

eGFR

lipoprotein(a) – once in patient’s lifetime, with initial screening

Optional:

Apolipoprotein B (ApoB)

Urine ACR (if eGFR <60 mL/min/1.73 m2, hypertension, or diabetes)

• Non-fasting lipid testing is recommended in most adults for screening; however, for individuals with a history of triglyceride levels >4.5 mmol/L, measurement of fasting lipid levels are recommended.
• it is now generally preferable to follow non-HDL-C or ApoB levels over LDL-C when interpreting lipid results, particularly when TG is ≥1.5 mmol/L.