Sandbox:Hyperlipoproteinemia type5: Difference between revisions
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Lifestyle therapies, such as appropriate nutrition and physical activity, are important elements of ASCVD risk reduction, with or without lipid-altering drug therapy. | Lifestyle therapies, such as appropriate nutrition and physical activity, are important elements of ASCVD risk reduction, with or without lipid-altering drug therapy. | ||
For patients in whom lipid-altering drug therapy is indicated, statin treatment is the primary pharmacologic modality for reducing ASCVD risk. | For patients in whom lipid-altering drug therapy is indicated, statin treatment is the primary pharmacologic modality for reducing ASCVD risk. | ||
[[Image:Clinical algorithm for screening and management of elevated TG.jpg|1200px|description]] | [[Image:Clinical algorithm for screening and management of elevated TG.jpg|1200px|description]] | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
When the triglyceride concentration is very high (≥500 mg/dL, and especially if ≥1000 mg/dL), the primary goal of therapy is to reduce the triglyceride level to , ≥500 mg/dL for the intent of reducing the risk of pancreatitis. | When the triglyceride concentration is very high (≥500 mg/dL, and especially if ≥1000 mg/dL), the primary goal of therapy is to reduce the triglyceride level to , ≥500 mg/dL for the intent of reducing the risk of pancreatitis. | ||
Revision as of 15:49, 28 November 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Person 1, Person 2, Your Name
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Any Disease from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
A reduced HDL-C level is associate with ASCVD
Diagnosis
Diagnosis of HLP type 5 is usually by clinical presentation.
- History (including age of onset of symptomes in the patient and family members).
- Physical findings such as eruptive xanthomas and tendon xanthomas.
- Laboratory evaluation such as lipid levels and apolipoprotein assays.
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
This summary should not be interpreted as rules or directives with regard to the most appropriate care of any single patient with dyslipidemia, because no set of recommendations or guidelines can have 100% applicability to an individual patient. Thus, evaluation and treatment decisions should be based on patient-centered, individual circumstances. As such, this document should be used in conjunction with, and not a replacement for the preferences of patients with dyslipidemia and the judgment of their treating clinicians.[1]
Lifestyle therapies, such as appropriate nutrition and physical activity, are important elements of ASCVD risk reduction, with or without lipid-altering drug therapy.
For patients in whom lipid-altering drug therapy is indicated, statin treatment is the primary pharmacologic modality for reducing ASCVD risk.
Medical Therapy
When the triglyceride concentration is very high (≥500 mg/dL, and especially if ≥1000 mg/dL), the primary goal of therapy is to reduce the triglyceride level to , ≥500 mg/dL for the intent of reducing the risk of pancreatitis.
| Triglyceride concentration | First line of therapy |
|---|---|
| ≥1000mg/dl | Triglyceride lowering agents such as ❑ Fibric acids ❑ High-dose [2 to 4 g/d] long-chain omega-3 fatty acids ❑ Nicotinic acid |
| 500-999mg/dl | ❑ Triglyceride lowering agents, ❑ Statins |
| 200-499mg/dl | Statin will generally be first-line drug therapy.If maximum tolerated statin therapy does not lower non-HDL-C below goal levels in patients with triglycerides 200 to 499 mg/dL, adding an agent that primarily lowers triglycerides may help to achieve atherogenic cholesterol goals. |
When triglycerides are between 200 and 499mg/dL, the primary targets of lipid therapy are non–HDL-C and LDL-C for the purpose of reducing ASCVD risk.
| Lipid treatment goals to reduce ASCVD risk[2] | ||
|---|---|---|
| Risk of ASCVD | Indication for drug therapy | Goal of drug therapy |
| Low ASCVD risk | Non HDL- C* level ≥190mg/dl LDL-C level ≥160mg/dl |
Non HDL- C level <130mg/dl LDL-C level <100mg/dl |
| Moderate ASCVD risk | Non HDL- C* level ≥160mg/dl LDL-C level ≥130mg/dl |
Non HDL- C level <130mg/dl LDL-C level <100mg/dl |
| High ASCVD risk | Non HDL- C level ≥130mg/dl LDL-C level ≥100mg/dl |
Non HDL- C level <130mg/dl LDL-C level <100mg/dl |
| Very high ASCVD risk | Non HDL- C level ≥100mg/dl LDL-C level ≥70mg/dl |
Non HDL- C level <100mg/dl LDL-C level <70mg/dl |
Non–HDL-C comprises the cholesterol carried by all atherogenic particles, including LDL, intermediatedensity lipoproteins, very low-density lipoproteins (VLDL) and VLDL remnants, chylomicron remnants, and lipoprotein.[1]
Secondary Prevention
- Lifestyle interventions are a key to efforts to reduce triglycerides that includes[2]
- weight loss if overweight or obese
- physical activity (≥ 150 minutes per week of moderate or higher intensity activity)
- Restriction of alcohol
- Restriction of sugar/refined carbohydrate intakes
- For patients with very high TG level (≥500 mg/dL),chylomicronemia will generally be present. For such patients, a low-fat diet (,15% of energy) may be helpful to reduce entry of new chylomicron particles into the circulation.[2]
- For patients with triglycerides <500 mg/dL, partial replacement of dietary carbohydrate (especially sugars and other refined carbohydrates) with a combination of unsaturated fats and proteins may help to reduce the triglyceride and non-HDL-C concentrations.
Case Studies
References
- ↑ 1.0 1.1 Bays HE, Jones PH, Orringer CE, Brown WV, Jacobson TA (2016) National Lipid Association Annual Summary of Clinical Lipidology 2016. J Clin Lipidol 10 (1 Suppl):S1-43. DOI:10.1016/j.jacl.2015.08.002 PMID: 26891998
- ↑ 2.0 2.1 2.2 Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH et al. (2015) National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol 9 (2):129-69. DOI:10.1016/j.jacl.2015.02.003 PMID: 25911072