Dyslipidemia

Low-density lipoprotein (LDL) (lousy)
- Increased LDL correlates with an increased risk of heart disease.
High-density lipoprotein (HDL) (happy)
- Increased HDL correlates with a decreased risk of heart disease.
Triglycerides
- An increase in triglycerides is correlated to a an increased risk of heart disease.

Causes and correlations

Straight out of the Merck Manual “The most important secondary cause in developed countries is a sedentary lifestyle with excessive dietary intake of saturated fat, cholesterol, and trans fats”
Genetics
Diabetes
Liver or kidney disease
Hypothyroidism
Alcoholism
Medications

Asymptomatic
Routine office visit
- Routine screening should begin at 35 for men and 45 for women
Signs of CAD

Xanthomas are possible, but more than half of people with them have an normal lipid profile.

Serum Lipid Profile (fasting)
Total Cholesterol
- Optimal < 200
- Borderline high 200–239
- High >240
HDL
- Low < 40
- High > 60
LDL
- Optimal < 100
- Near Optimal 100–129
- Borderline high 130–159
- High 160–189
- Very high >190
Triglycerides
- Normal < 150
- Borderline high 150–199
- High 200–499
- Very high >500

Non-pharmacological
- Diet
  - Reduce dietary fat to 30% and saturated fat to < 10%
  - Mediterranean diet
- Increase in aerobic exercise helps to increase HDL levels
- Weight reduction
Medications
- 81 mg or 325 mg of Aspirin Daily for those with elevated LDL
- Statins
  - 3-Hydroxy–3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA inhibitors)
  - Inhibit rate limiting step in cholesterol production
  - Examples
    - Lovastatin, Pravastatin, Simvastatin, Atorvastatin
  - Most common side effect – Myositis
Postmenopausal estrogen replacement helps lower LDL and raise HDL
Niacin is effective but may cause flushing in patients and is not well tolerated
Bile acid binding resins
- Cholestyramine, Colestipol,
Fibric acid derivatives
- Gemfibrozil, Fenofibrate