Dyslipidemia resident survival guide: Difference between revisions

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{{familytree | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |A01='''Identify risk factors for CAD'''<br><br>
{{familytree | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Identify risk factors for CAD'''<br><br>


'''''Major risk factors:'''''<br>
'''''Major risk factors:'''''<br>
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❑ ApoE4 isoform<br>
❑ ApoE4 isoform<br>


❑ ↑ uric acid}}
❑ ↑ uric acid</div>}}
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{{familytree | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |B01=Determine the 10-year risk of coronary event using ANY of the following assessment tools:<br>
{{familytree | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; width: 18em; padding:1em;">Determine the 10-year risk of coronary event using ANY of the following assessment tools:<br>


❑ Framingham Risk Assessment Tool (To be redirected to Framingham Risk Assessment Tool, click [http://cvdrisk.nhlbi.nih.gov/ here])
❑ Framingham Risk Assessment Tool (To be redirected to Framingham Risk Assessment Tool, click [http://cvdrisk.nhlbi.nih.gov/ here])
❑ Reynolds Risk Score (To be redirected to Reynolds Risk Score website, click [http://www.reynoldsriskscore.org/ here])}}
❑ Reynolds Risk Score (To be redirected to Reynolds Risk Score website, click [http://www.reynoldsriskscore.org/ here])</div>}}


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{{familytree | | | | | F01 | | | | | | | F02 | | | | | | | | | | | F03 | | | | | | | | | | | | | |F01='''Does the patient have ALL the following criteria for low-risk dyslipidemia during previous work-up?'''<br>
{{familytree | | | | | F01 | | | | | | | F02 | | | | | | | | | | | F03 | | | | | | | | | | | | | |F01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Does the patient have ALL the following criteria for low-risk dyslipidemia during previous work-up?'''<br>


❑ Low LDL-C < 100 mg/dL, '''AND''' <br>
❑ Low LDL-C < 100 mg/dL, '''AND''' <br>
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❑ HDL-C > 50 mg/dL, '''AND''' <br>
❑ HDL-C > 50 mg/dL, '''AND''' <br>


❑ Triglycerides < 150 mg/dL|F02=Adult patient|F03=Pediatric patient (age > 2 years)}}
❑ Triglycerides < 150 mg/dL|F02=Adult patient|F03=Pediatric patient (age > 2 years)</div>}}


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{{familytree | L01 | | L02 | | L03 | | L04 | | L05 | | L06 | | | | | | | | | | | | | | | | | | | |L01=Screen every 5 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L02=Screen every 1 to 2 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L03=Screen annually|L04=Screen every 5 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L05=Screen every 1 to 2 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L06=Screen annually}}
{{familytree | L01 | | L02 | | L03 | | L04 | | L05 | | L06 | | | | | | | | | | | | | | | | | | | |L01=Screen every 5 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L02=Screen every 1 to 2 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L03=Screen annually|L04=Screen every 5 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L05=Screen every 1 to 2 years<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>|L06=Screen annually}}
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<br><span style="font-size:65%;color:red">More frequent screening is recommended for patients with risk factors for CAD (shown above)</span>


==Complete Diagnostic Approach==
==Complete Diagnostic Approach==

Revision as of 15:48, 20 April 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Classification

Causes

Secondary causes of dyslipidemia may cause either an increase in total-cholesterol & low density lipoprotein-cholesterol (LDL-C) or an increase in total triglycerides & very low density lipoprotein cholesterol (VLDL-C). Common causes are listed below.

Increase in Total Cholesterol and LDL-C

  • Hypothyroidism
  • Nephrosis
  • Dysgammaglobulinemia (systemic lupus erythematosus, multiple myeloma)
  • Cholestatic hepatic diseases due to abnormal lipoproteins (e.g. primary biliary cirrhosis)
  • Administration of protease inhibitors (treatment for HIV infection)
  • Administration of progestin or anabolic steroids

Increase in Total Triglycerides and VLDL-C

  • Chronic kidney disease
  • Type 2 diabetes mellitus
  • Obesity
  • Excessive alcohol intake
  • Hypothyroidism
  • Administration of anti-hypertensive therapy (thiazide diuretics or B-blockers)
  • Administration of corticosteroids
  • Severe stress that increases endogenous corticosteroid concentration
  • Elevated concentrations of estrogen (administration of oral (not transdermal) estrogen therapy, oral contraceptives, or pregnancy)
  • Administration of protease inhibitors (treatment for HIV infection)


To view a comprehensive list of dyslipidemia causes, click here

Screening

Abbreviations: ASA: American society of anesthesiologists; BP: Blood Pressure; CCS: Canadian cardiovascular society; CrCl: Creatinine clearance; CXR: Chest X-ray; DNI: Do not intubate; DNR: Do not resuscitate; ECG: Electrocardiogram; eGFR: estimated glomerular filtration rate; HR:Heart rate; INR: International normalized ratio; LMWH: Low molecular weight heparin; LV: Left ventricle; LVED: Left ventricular ejection fraction; NOAC: Novel oral anticoagulant; NPO: Nothing per os; PMI: Point of maximal impulse; PT: Prothrombin time; RR: Respiratory rate; SpO2: Oxygen saturation; T: Temperature; VT: Ventricular tachycardia

 
 
 
 
 
 
 
 
 
 
 
Identify risk factors for CAD

Major risk factors:

❑ Advanced age

❑ ↑ total serum cholesterol

❑ ↑ non-HDL-C (calculated by: total cholesterol minus HDL-C)

❑ ↑ LDL-C (either measured or calculated by: total cholesterol minus HDL-c minus (total triglycerides/5))

❑ ↓ HDL-C

❑ Diabetes mellitus

❑ Hypertension

❑ Cigarette smoking

❑ Family history of CAD

Additional risk factors:

❑ Obesity, especially abdominal

❑ Family history of hyperlipidemia

❑ Small, dense LDL-C

❑ ↑ Apo-B

❑ ↑ LDL particle number (measured by ApoB)

❑ Fasting/postprandial hypertriglyceridemia

❑ Polycystic ovarian syndrome

❑ Dyslipidemic triad

Non-traditional risk factors:

❑ ↑ lipoprotein

❑ ↑ clotting factors

❑ Inflamamtory markers (e.g. hsCRP or Lipoprotein-associated phospholipase A2 (Lp-PLA2)

❑ Hyperhomocysteinemia

❑ ApoE4 isoform

❑ ↑ uric acid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Determine the 10-year risk of coronary event using ANY of the following assessment tools:

❑ Framingham Risk Assessment Tool (To be redirected to Framingham Risk Assessment Tool, click here)

❑ Reynolds Risk Score (To be redirected to Reynolds Risk Score website, click here)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High
(Framingham 10-year global risk > 20%)
 
Intermediate
(Framingham 10-year global risk between 10% and 20%)
 
 
 
Lower
(Framingham 10-year global risk < 10%)
 
Optimal
(Framingham 10-year global risk < 10% with optimal levels or risk factors and heart-healthy lifestyle)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient have type 2 diabetes mellitus?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient have ALL the following criteria for low-risk dyslipidemia during previous work-up?

❑ Low LDL-C < 100 mg/dL, AND

❑ HDL-C > 50 mg/dL, AND

❑ Triglycerides < 150 mg/dL
 
 
 
 
 
 
Adult patient
 
 
 
 
 
 
 
 
 
 
Pediatric patient (age > 2 years)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes. The patient has ALL of the criteria for low-risk dyslipidemia
 
Either unknown history of lipid profile or No, the patient does not have ALL of the criteria for low-risk dyslipidemia (at least 1 criterion is not met)
 
 
 
 
Does that patient have risk factors for CAD (listed above)?
 
 
 
 
 
 
 
 
 
 
Does the patient have risk factors for CAD (listed above)?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Screen every 2 years
 
Screen annually
 
No
 
 
 
Yes
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Screen patient more frequently than patients with no risk factors based on clinical judgement (unknown optimal interval)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Male patient
 
 
 
 
 
 
 
 
 
Female patient
 
 
 
 
 
Screen every 3 to 5 years
 
Do not screen patient for dyslipidemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Age 20 to 45 years
 
Age > 45 to 65 years
 
Age > 65 years
 
Age 20 to 55 years
 
Age > 55 to 65
 
Age > 65
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Screen every 5 years
More frequent screening is recommended for patients with risk factors for CAD (shown above)
 
Screen every 1 to 2 years
More frequent screening is recommended for patients with risk factors for CAD (shown above)
 
Screen annually
 
Screen every 5 years
More frequent screening is recommended for patients with risk factors for CAD (shown above)
 
Screen every 1 to 2 years
More frequent screening is recommended for patients with risk factors for CAD (shown above)
 
Screen annually
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Complete Diagnostic Approach

Treatment

Do's

Don'ts

References