Dyslipidemia
 |
 |
|||||||||
|
||||||||||
 |
 |
DYSLIPIDEMIA
I. LIPOPROTEINS
- The plasma lipoproteins are divided into five major classes based on their relative density.
- Each lipoprotein class comprises a family of particles that vary slightly in
+ Density
+ Size
+ Migration during electrophoresis
+ And protein composition.
[IMG][/IMG]
- Most plasma triglyceride is transported in chylomicrons or VLDLs, and most plasma cholesterol is carried as cholesteryl esters in LDLs and HDLs.
II. SCREENING
The NCEP ATPIII (Adult Treatment Panel (ATP) convened by the National Cholesterol Education Program (NCEP) of the National Heart Lung and Blood Institute ) guidelines published in 2001: all adults over age 20 should have plasma levels of cholesterol, triglyceride, LDL-C, and HDL-C measured after a 12-hour overnight fast.
III. DIAGNOSIS
- Although many patients with hyperlipidemia have a primary or genetic cause of their lipid disorder, secondary factors frequently contribute to the hyperlipidemia.
1. A fasting glucose should be obtained in the initial work-up of all subjects with an elevated triglyceride level.
2. Nephrotic syndrome and chronic renal insufficiency should be excluded by obtaining urine protein and serum creatinine.
3. Liver function tests should be performed to rule out hepatitis and cholestasis.
4. Hypothyroidism should be ruled out by measuring serum TSH.
- Patients with hyperlipidemia, especially hypertriglyceridemia, who drink alcohol or are obese should be encouraged to decrease their intake. Sedentary lifestyle, obesity, and smoking are all associated with low HDL-C levels, and patients should be counseled about these issues.
- Once secondary causes for the elevated lipoprotein levels have been ruled out, attempts should be made to diagnose the primary lipid disorder since the underlying etiology has a significant effect on the risk of developing CHD, on the response to drug therapy, and on the management of other family members. Often, determining the correct diagnosis requires a detailed family medical history and, in some cases, lipid analyses in family members.
IV. NONPHARMACOLOGIC TREATMENT
Diet: An important component in the management of dyslipidemia.
- elevated LDL-C, dietary saturated fat and cholesterol should be restricted.
- hypertriglyceridemia, the intake of simple carbohydrates should be curtailed.
- severe hypertriglyceridemia (>1000 mg/dL), restriction of total fat intake is critical.
The most widely used diet to lower the LDL-C level is the "Step I diet" developed by the American Heart Association. Most patients have a relatively modest (<10%) decrease in plasma levels of LDL-C on a step I diet in the absence of any associated weight loss.
Almost all persons experience a decrease in plasma HDL-C levels with a reduction in the amount of total and saturated fat in their diet.
Foods and Additives: Certain foods and dietary additives are associated with modest reductions in plasma cholesterol levels.
- Plant stanol and sterol esters are available in a variety of foods such as spreads, salad dressings, and snack bars interfere with cholesterol absorption and reduce plasma LDL-C levels by ~10% when taken three times per day.
- Psyllium, soy protein, or Chinese red yeast rice (which contains lovastatin) can have modest cholesterol-lowering effects.
Weight Loss and Exercise:
- Plasma triglyceride levels tend to fall and HDL-C levels tend to increase in obese subjects after weight reduction.
- Regular aerobic exercise can also have a positive effect on lipids
- Aerobic exercise has a very modest elevating effect on plasma levels of HDL-C in most individuals but also has cardiovascular benefits that extend beyond the effects on plasma lipid levels.
Trả Lời Với Trích Dẫn
Nguyên văn bởi skinnystorm-duyquang
9 bước tiếp cận bệnh nhân rối loạn lipid máu (ATP III)
