Lipid Disorders

Lipid Disorders-
-Hypercholesterolemia-

-Lipid disorders occur either as a result of one or more genetic abnormalities or secondary to underlying disease
-Family history of hypercholesterolemia is a major risk factor
-High levels of cholesterol have been shown to lead to atherosclerosis and lead to coronary heart disease
-the first line recommendation in the treatment of hypercholesterolemia is diet modification and exercise
-Low HDL is also an indication for instituting therapy
-Weight loss has been shown to lower LDL levels by 5-7 percent
-Statins can reduce the cardiovascular risk by 20-30 percent regardless of the baseline LDL
-Patients that are given a medication to lower LDL should be given a statin
-if patients have known coronary heart disease or have a similar risk should be treated with a higher dose of the statin (ex Lipitor 40-80 mg or Crestor 20-40 mg) regardless of the baseline LDL
-patients with acute coronary syndrome and those with similar risk Crestor 80 mg daily
-Patients with stable cardiovascular disease should get at least a 50 percent reduction of the LDL or a LDL level of less than 100 or have their dose increased
-If patients are on the high statin dose, a second LDL lowering medicine should be added

-Hypertriglyceridemia-

-Lipid disorders occur either as a result of one or more genetic abnormalities or secondary to underlying disease
-the primary dyslipidemias are associated with an overproduction or impaired removal of lipoproteins

-Normal triglycerides is less than 150
-Borderline high is 150-199
-High 200-499
-Very High over 500

-elevated triglyceride levels are independently associated with cardiovascular risk
-there is an association between elevated triglycerides and coronary heart disease
-non fasting triglyceride elevations have been showed to show increase risk for ischemic stroke
-many acquired disorders, conditions, and therapies raise serum triglycerides:  obesity, diabetes mellitus, nephrotic syndrome, hypothyroidism, pregnancy, tamoxifen, beta blockers, immunosuppressive medications, HIV medications, retinoids, and estrogen replacement

-Family history is a strong risk factor for development of hypertriglyceridemia

-Mild to Moderate Hypertriglyceridemia (150-500) should be treated with lifestyle modifications.  Cardiovascular risk reduction with statins is best accomplished when instituting medications

-Gemfibrozil has been shown to reduce triglyceride levels by 31 percent and raise HDL

-Severe Hypertriglyceridemia (>500) are at increased risk for pancreatitis.  It is recommended to decrease level so there is no development of pancreatitis.  This can be done with statins or Gemfibrozil

-Fibrates (Fenofibrate or Gemfibrozil) , Nicotinic Acid, and fish oil can also be used to help lower triglyceride levels