Hyperlipidemias Flashcards
What is a lipid profiled
Total Cholesterol
LDL
HDL
TGs
Acanthosis Nigricans
Associated with insulin reisstance….seen in T2DM, PCOS, pre-diabetes
Suspect high TG, low HDL (TG>150)
Eruptive xanthoma
Palpable, non-pruritic, usually on pressure points
Suspect high TG, low HDL (TG>1000)
Tendon xanthoma
Visible or palpable thickening of achilles tendon, absence of previous injury
Associated with familial hypercholesterolemia, suspect very high TC, LDL (LDL>300)
Lipemia retinalis
TG>2000
Chylomicronemia syndrome
Expect pancreatitis
When to lower TGs
Over 1000 - YES
Under 150 - NO
200-500 - maybe
500-1000 - probably
Cholesterol screening
Fasting lipoprotein every 5 years starting at age 20
If non-fasting, get full profile if TC>200 or HDL<40
Assessment of risk
Count CV risk factors
If 2 or more, then calculate 10 year risk using Framingham risk calculator
CVD risk factors
Smoking HTN FH of premature CHD Age (over 45 men, over 55 women) HDL<40 CHD or equiv - DIABETES
ASCVD statin benefit groups
Under 75 y/o - high intensity
Over 75 - mod intensity
LDL>190 - high intensity
Diabetes, age 40-75 - moderate or high intensity
10 year risk>7.5 0 mod to high intensity statin
High vs. low intensity statins
High - lowers LDL over 50…atorva 40,80 or rosuva 20,40
Mod - 30-50%
High TGs
Diabetes, obsesity, dialysis, alcohol, B blocker, estrogen, resins, retinoids
High cholesterol AND Tg
Hypothyroidism Nephrotic syndrome Cushings Acromegaly Diuretics Protease inhibitors Transplant meds
Hetero FH mutations
LDLR or apoB or PCSK9
Insulin def
Reduces LPL, inc VLDL production and dec VLDL clearance thus exacerbates hypertriglyceridemia
Other exacerbating favotrs include hypothyroidism, renal probs, alcohol, estrogen and other meds
