Dyslipidemia / Reading and Sharing

Dyslipidemia Also known as hypercholestrolemia, is diagnosed when a patient has a cholesterol level equal or greater than 200 mg/dl.

The incidence and prevalence increase as we age. Starting at age 20, 48% of men and 50% of women who are Caucasian have dyslipidemia. 45% of black men and 42% of black women. Hispanic population are equal for men and women at 50%. (Ferri, 2018). Women with polycystic ovary syndrome are more prevalent to have dyslipidemia. Prevalence varies, Increases with chronic heart disease. Strong relationship to BMI, and at a higher incidence in the industrialized countries (Epocrates, 2018).

Pathophysiology of Dyslipidemia is elevated plasma cholesterol, triglycerides or both, or a low high-density lipoprotein level, in turn may contribute to the development of atherosclerosis. Causes may be genetic or secondary. Usually diagnosed by measuring plasma levels of total cholesterol, triglycerides and individual lipoproteins (Goldberg, 2015, p. 1). Primary would consist of multiple things, genetics, obesity, and dietary intake. Secondary would include: hypothyroidism, diabetes mellitus, nephrotic syndrome, obstructive liver disease, alcohol or tobacco use, dysgammaglobulinemia and medications (oral contraceptives, progesterone, corticosteroids, thiazide diuretics, b-blockers, androgenic steroids, retinoic acid derivatives, and protease inhibitors) (Ferri, 2018, p. 645).

Physical assessment would start with medication history, measurements of BMI and BP, thyroid and liver assessments, lastly examining peripheral pules including carotids for bruits. Signs and symptoms can be seen on the body, they would consist of eruptive Xanthoma, tuberous xanthoma, tendinous xanthoma and xanthoma in the eyelid. (there are great pictures at this site: http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia. Testing would start with a Lipid profile, which should be done after fasting for 12 hours to look for primary dyslipidemia. Now, for secondary you may want to include fasting glucose, liver enzymes, creatinine, thyroid-stimulating hormone and urinary protein. You should also screen patient that have diabetes, cigarette use, hypertension and family history of CAD in males with 1st-degree relative before the age of 55 and female before the age of 65.

Patient Education: Provide the patient with the information about diet and exercise and the risk factors associated to dyslipidemia they may have.

Treatment: Primarily starting with patient education on diet and exercise. Then for moderate intensity Atorvastatin 10-20 mg, Rosuvastatin 5-10 mg, Simvastatin 20-40 mg, Pravastatin 40-80 mg are the primary meds, there is a variety of choices that can be limited by insurance approval. For higher intensity it is limited to atorvastatin 40-80 mg and rosuvastatin 20-40 mg.

References:

Epocrates (2018). Dyslipidemia. Retrieved from https://online.epocrates.com/diseases/17011/Hypercholesterolemia/Key-Highlights

Ferri, F.F. (2018). Ferri’s Clinical Advisor 2018: 5 Books in 1. Philadelphia, PA. ELSEVIER

Goldberg, A. C. (2015). Dyslipidemia. Merck Manual, Professional Version. Retrieved from http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia