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Dyslipidemia
Definition
Classification
Signs and symptoms
Primary causes
Secondary causes
Evaluation
Treatment
Dyslipidemia
Dyslipidemia
Dyslipidemia
Fredrickson Classification
Lipoprotein Patterns (Fredrickson Phenotypes)
Phenotype
I
IIa
IIb
III
IV
V
Elevated Lipoprotein(s)
Chylomicrons
LDL
LDL and VLDL
Elevated Lipids
TGs
Cholesterol
TGs and
cholesterol
VLDL and chylomicron remnants TGs and
cholesterol
VLDL
TGs
Chylomicrons and VLDL
TGs and
cholesterol
Classification of
dyslipidemias
Planar xanthoma
Planar xanthoma
Tendinous xanthoma
Tendinous xanthoma
Tendinous xanthoma
Eruptive xanthoma
Eruptive xanthoma
Tuberous xanthoma
Palmar xanthoma
Tuberous xanthoma
Xanthelasma
10
Xanthelasma
Lipemia retinalis
11
Lipemia retinalis
Arcus corneae
12
Lipoprotein
13
14
Polygenic hypercholesterolemia
Unknown genetic defect; likely multiple
defects and mechanisms
Variable inheritance
Common
Premature CAD
TC 250350 mg/dL
15
16
Familial hypertriglyceridemia
Unknown defect
Autosomal dominant
1/50 to 1/100
Premature CAD, 15% of AMIs < 60 yr; obesity
and insulin resistance; low HDL, hyperuricemia
Small, dense LDL; apo B elevated
TC 250500 mg/dL
TG 250750 mg/dL
17
Familial dysbetalipoproteinemia
Defect in Apo E (usually e2/e2 homozygotes);
diminished chylomicron and VLDL clearance
Recessive (more common) or dominant (less
common)
1/5000
Xanthomas (especially palmar), yellow palmar
creases, premature CAD
TC 250500 mg/dL
TG 250500 mg/dL
Secondary causes
diabetes mellitus
alcohol abuse
chronic renal insufficiency, nephrotic syndrome
hypothyroidism
primary biliary cirrhosis and other cholestatic liver
diseases,
Drugs: thiazides, -blockers, retinoids, highly-active
antiretroviral agents, estrogen and progestins, and
glucocorticoids
18
Diabetic dyslipidemia
19
20
21
Additional testing
22
Evaluation
1. Measure fasting lipoproteins
2. Identify CAD or CAD equivalents
Cigarette smoking
Hypertension (BP 140/90 or on antihypertensive drug)
Low HDL ( 40 mg/dL
Family history of premature CAD - 1st-degree relative
male < 55 yr
female < 65 yr
Age (men 45 yr, women 55 yr)
Evaluation
23
http://hp2010.nhlbihin.net/atpiii/calculat
or.asp
http://www.mdcalc.com/framinghamcoronary-heart-disease-risk-score-siunits/
http://www.medcalc.com/heartrisk.html
http://reference.medscape.com/calculato
r/framingham-coronary-risk-ldl
24
Desirable
Borderline high
High
Optimal
Near optimal/above optimal
Borderline high
High
Very high
Low
High
Desirable
Borderline high
High
Very high
25
Non-HDL-C
Goal (mg/dL)
<100
<130
<130
<160
01 Risk Factor
<160
<190
Risk Category
26
Treatment
27
Drug therapy
28
29
30
31
32
33
34
Treatment of diabetic
dyslipidemia
35
Treatment of diabetic
dyslipidemia
36
37