Dyslipidemia

From WikiProjectMed
Jump to navigation Jump to search
Dyslipidemia
Xanthelasma palpebrarum.jpg
Yellowish patch consisting of cholesterol above the eyelids. These are more common in people with familial hypercholesterolemia.
SpecialtyCardiology
SymptomsNone, yellowish lipid deposits in the skin[1][2]
ComplicationsHeart disease, stroke, pancreatitis[1][2]
TypesPhenotype I, IIa, IIb, III, IV, V[1]
Risk factorsGenetics, poor diet, inactivity, obesity, smoking, diabetes, nephrotic syndrome, biliary obstruction, hypothyroidism, certain medications[1][2]
Diagnostic methodBlood tests for total, LDL, and HDL cholesterol, and triglycerides[1]
TreatmentLifestyle changes, medications[1]
FrequencyCommon[1]

Dyslipidemia is an abnormal amount of lipids (fats) in the blood.[1] It is divided into six types which result in some combination of high total cholesterol, high LDL cholesterol, low HDL cholesterol, high triglycerides, or high apolipoprotein B.[1] There are generally no symptoms, though occasionally yellowish lipid deposits within the skin occur.[1][2] Complications may include heart disease, stroke, and pancreatitis.[1][2]

Causes may include poor diet, inactivity, obesity, excessive alcohol, and smoking.[1][2] Other health conditions that can result in dyslipiedmia include diabetes, nephrotic syndrome, biliary obstruction, hypothyroidism, and certain medications.[1][2] Some types run in families such as familial hypercholesterolemia.[1] Diagnosis is generally by blood tests for total, LDL, and HDL cholesterol, and triglycerides.[1]

Treatment involves lifestyle changes including a diet high in vegetables and exercise.[1] Other treatments depend in part on the types of dyslipidemia.[2] If medications are used, the initial choice is generally a statin.[1] Dyslipidemia becomes more common with age.[1] In the United States high cholesterol affects about 34% of those over the age of 20.[1]

Types

Increases Decreases
Lipid
Lipoprotein
Both

Diagnosis

Classification

Dyslipidemias are classified in two ways:

  • Presentation in the body (including the specific type of lipid that is increased)
  • Underlying cause for the condition (genetic, or another condition).[2] This classification can be problematic, because most conditions involve the intersection of genetics and lifestyle issues. However, there are a few well-defined genetic conditions that are usually easy to identify.

Fredrickson Classification:[3][1]

Phenotype I IIa IIb III IV V
Elevated lipoprotein Chylomicron LDL LDL and VLDL IDL VLDL VLDL and chylomicrons

Screening

Testing the general population under the age of 40 without symptoms is of unclear benefit.[4][5] Testing is not needed more often than every 10 years at most.[6] These can be done non fasting.[6]

Management

A Mediterranean diet and exercise is recommended.[6]

Medications

If medications are used the first line treatment is generally statins.[1] With statins, the goal is to increase the medication to a specific dose, rather than adjust the medication to a cholesterol level.[6]

Other medications that can be used include ezetimibe.[1] Fibrates may be used for high blood triglycerides.[2] When used together with statins they may cause muscle breakdown.[1]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 Pappan, N; Rehman, A (January 2020). "Dyslipidemia". PMID 32809726. Cite journal requires |journal= (help)
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 "Dyslipidemia - Endocrine and Metabolic Disorders". Merck Manuals Professional Edition. Retrieved 20 November 2020.
  3. Fredrickson DS, Lees RS. A system for phenotyping hyperlipoproteinemia. Circulation 1965;31:321-327.
  4. Bibbins-Domingo, Kirsten; Grossman, David C.; Curry, Susan J.; Davidson, Karina W.; Epling, John W.; García, Francisco A. R.; Gillman, Matthew W.; Kemper, Alex R.; Krist, Alex H.; Kurth, Ann E.; Landefeld, C. Seth; Lefevre, Michael; Mangione, Carol M.; Owens, Douglas K.; Phillips, William R.; Phipps, Maureen G.; Pignone, Michael P.; Siu, Albert L.; Siu, A. L. (August 9, 2016). "Screening for Lipid Disorders in Children and Adolescents". JAMA. 316 (6): 625–33. doi:10.1001/jama.2016.9852. PMID 27532917.
  5. Chou, R; Dana, T; Blazina, I; Daeges, M; Bougatsos, C; Jeanne, TL (18 October 2016). "Screening for Dyslipidemia in Younger Adults: A Systematic Review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 165 (8): 560–564. doi:10.7326/m16-0946. PMID 27538032.
  6. 6.0 6.1 6.2 6.3 O'Malley, Patrick G.; Arnold, Michael J.; Kelley, Cathy; Spacek, Lance; Buelt, Andrew; Natarajan, Sundar; Donahue, Mark P.; Vagichev, Elena; Ballard-Hernandez, Jennifer; Logan, Amanda; Thomas, Lauren; Ritter, Joan; Neubauer, Brian E.; Downs, John R. (22 September 2020). "Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline". Annals of Internal Medicine. doi:10.7326/M20-4648.

External links

Classification