Dyslipidemia: Also known as hypercholestremia, is diagnosed when a patient has a cholesterol level >= 200 mg/dl.
Incidence/Prevalence: Prevalence of this disorder is large, over 105 million adults in the U.S.. The incidence and prevalence increase as we age. Starting at age 20, approximately 48% of Caucasian men and 50% of Caucasion women, and 45% of black men and 42% of black women have dyslipidemia. Hispanic population are equal for men and women at 50%. (Ferri, 2018, p. 646). Women with polycystic ovary syndrome are more prevalent to have dyslipidemia. Prevalence varies, it increases with chronic heart disease, has strong relationship to BMI, and at a higher incidence in the industrialized countries (Epocrates, 2018).
Pathophysiology/Etiology: Genetics, obesity, and diet are the primary cause. Hypothyroidism, diabetes melletus, nephrotic syndrome, obstructive liver, alcohol, tobacco use, and side effects of medications are a secondary cause of hyperlipidemia. Medications that may cause this are thiazides, beta-blockers, estrogens, corticosteroid. Those who have the immediate family members with hyperlipidemia are at higher risk.
Physical Assessment and examination: As a provider obtaining a good health history, measuring BMI and B/P, thyroid and liver. Check the peripheral pulses, cartoids for bruits. Begin proper screenings of lipid panel starting as early as age 2 if they have risk factors such as family history of dyslipidemia, premature cardiovascular diseas, diabeties, or BMI> 85th %. If results are normal retest every 3-5 years. And begin routine screening in all children 9-11 (Collins-Bride, Saxe, Duderstadt, & Kaplan, 2017). 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.
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 medications. 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:
Collins-Bride, G.M., Saxe, J.M., Duderstadt, K.G., & Kaplan, R. (2017). Clinical Guidelines for Advanced Practice Nursing: An Interprofessional Approach (3rd ed.). Jones & Bartlett Learning. Burlington, MA.
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
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