5. dyslipidemia UPDATED GUIDELINES 2021 ACCP (1).pdf

Therapy 1 - Dyslipidemia D X SOURCE: ACCP Updates in Therapeutics® 2023 and pharmacotherapy handbook 11 th edition:2024Pharmacotherapy Preparatory Review and Recertification Course  LECTURE OUTLINE ❑ Background...

Therapy 1 - Dyslipidemia D X SOURCE: ACCP Updates in Therapeutics® 2023 and pharmacotherapy handbook 11 th edition:2024Pharmacotherapy Preparatory Review and Recertification Course  LECTURE OUTLINE ❑ Background/Introduction ❑ Hyperlipidemia/Dyslipidemia ❑ Diagnosis ❑ Treatment/nonpharmacological maneymant ❑-Treatment/pharmacological Coreytrof good ❑ Low HDL/ causes and treatment ❑ Hyperlipidemia in pregnancy ❑ Hypertriglyceridemia ❑ Monitoring 2024 BACKGROUND/ INTRODUCTION 2024  W: , Background Cholesterol, triglycerides, and phospholipids are the major lipids in the body in - Cholesterol plays the central role in the pathogenesis of ↑ - & & atherosclerosis Lipids are relatively water insoluble molecules, plasma - lipids are transported by lipoprotein particles ↑ K 2024 P F  Background * Atherogenesis is a progressive process initiated by migration of LDLC + lipoprotein into vessel walls. These particles undergo oxidation and are taken up by macrophages, which induces endothelial cell dysfunction that reduces the ability of the endothelium to dilate the artery and causes a prothrombotic state. 2024  Background Lipid abnormalities (Eventual clinical outcomes ) increase the risk of 1. coronary, (CHD) 2. Cerebro vascular (CVA), and 3. peripheral arterial disease (PAD), 4. collectively known as atherosclerotic cardiovascular -- - disease (ASCVD). leg PAD 2024  Hyperlipidemia ↓ Elevated blood levels of lipoproteins (cholesterol, triglycerides, - phospholipids) Lipoprotein abnormalities (dyslipidemia): > 1 of the following: Elevated total cholesterol&(TC) Elevated low-density lipoprotein (LDL) & Elevated triglycerides (TG) - Reduced high-density lipoprotein (HDL) - So … ↓TC, ↓ LDL, ↑HDL reduces mortality/CHD events 2024  Lipoprotein disorders: A. (Primary dyslipidemia) 79 42. -18) 1. Primary dyslipidemias include genetic defects resulting in hypercholesterolemia, hypertriglyceridemia, and disorders of HDLC metabolism and an excess of lipoproteins. 2. These disorders have an increased risk of premature ASCVD due to significant elevations in cholesterol levels. 2024  Lipoprotein disorders: 1. In homozygous and heterozygous familial * A. (Primary dyslipidemia) hypercholesterolemia (FH), the primary defect is the inability to bind LDLC to LDLC receptors. 2. This leads to lack of LDLC degradation by cells and unregulated biosynthesis of cholesterol. ↑ - 2024  Secondary dyslipidemia Secondary dyslipidemias should be initially managed by correcting underlying abnormality when possible Several drug classes and habits may affect lipid levels (eg, 1. excessive alcohol use, weight gain, 2. excessive intake of carbohydrates or saturated fat), - 3. thiazide diuretics, progestins jaisies 4. glucocorticoids, sirolimus. 5. β-blockers, isotretinoin, cyclosporine /mirtazapine). 2024  Effect on Plasma Lipids Cholesterol (%) Triglycerides (%) HDL-C (%) Comments Diuretics Thiazides ↑5–7% initially ↑30–50 ↑1 Effects transient; monitor for long- ↑0–3% later term effects Loop No change No change ↓ to 15 β-blockers Nonselective No change ↑20—50 ↓10–15 Selective β-blockers have greater Selective No change ↑15–30 ↓5–10 effects than nonselective; β-blockers α-Blocking No change or ↓ No change No change with ISA or α-blocking effects are lipid neutral α-Agonists and antagonists ↓0–10% ↓ 0–20 ↑0–15 In general, drugs that affect α- (e.g., prazosin and clonidine) receptors ↓cholesterol and ↑HDL-C Oral contraceptives α-Monophasics ↑5–20 ↑10–45 ↑15 to ↓15 Effects caused by reduced lipolytic activity and/or ↑VLDL synthesis; mainly caused by progestin component; estrogen alone protective α-Triphasics ↑10–15 ↑10–15 ↑5–10 Glucocorticoids ↑5–10 ↑15–20 Ethanol No change ↑up to 50 ↑ Marked elevations can occur in patients who are hypertriglyceridemic Isotretinoin ↑5–20 ↑50–60 ↓10–15 Changes may reverse 8 wk after stopping drug 2024 Cyclosporine ↑15–20 No change No change CLINICAL PRESENTATION & DIAGNOSIS * i& 2024 CLINICAL PRESENTATION ❖ Most patients are asymptomatic for years before they develop ASCVD, which may produce symptoms including (iii) 1. chest pain, 2. palpitations, 3. sweating, 4. anxiety, 5. shortness of breath, 6. loss of consciousness, 7. difficulty with speech or movement, 8. or abdominal pain. 2024 DIAGNOSIS Measure fasting lipoprotein profile (total cholesterol, LDL, HDL, triglycerides) in all adults 20 years of age or older at least once every 5 years. Measure plasma cholesterol, triglyceride and HDL levels after a 12-hour fast because triglycerides may be elevated in non-fasting individuals; total cholesterol is only modestly affected by fasting. If the total cholesterol is greater than 200 mg/dL (>5.17 mmol/L), a second determination is recommended, and if the values are greater than 30 mg/dL (>0.78 mmol/L) apart, use the average of values. 2024  Laboratory tests Laboratory tests may show elevated ↑ TC, ↑ LDL-C, ↑ TG, ↑ apo-lipoprotein B, and high sensitivity C-reactive protein (↑ hs-CRP); ↓ HDL-C may be low. Perform other baseline testing (eg, AST/ALT, TSH, glucose, serum creatinine, BUN, and urinalysis). Calculate 10 year ASCVD risk in primary prevention situations. Available at http://tools.acc.org/ASCVD-Risk-Estimator 2024 Table 23-6 Classification of Total, LDL, and HDL Cholesterol, and Triglycerides Total cholesterol (All values are given in milligrams per deciliters.)