Cholesterol Flashcards
When is cholesterol screening done?
Measurement of total cholesterol and HDL every 5 years once pt turns 20 y/o is considered reasonable. Start sooner and screen more frequently for obese pts and those with family hx of hypercholesterolemia.
What physical findings are clues to hypercholesterolemia?
Xanthelasma (deposits on inner eyelids), tendon xanthomas (deposits in skin), corneal arcus in young patients, “milky”-appearing serum, obesity
*Pancreatitis in absence of obvious risk factors may be a marker for familial hypercholesterolemia
What lipid level is usually the main player for treatment decisions?
LDL
Patient with no coronary heart disease risk factors. What is the treatment if LDL 190?
190 - meds + diet
Patient with more than 2 coronary heart disease risk factors. What is the treatment if LDL 130?
130 - meds + diet
Patient with known coronary artery disease. What is the treatment if LDL 100?
100 - meds + diet
Patient at very high risk (e.g. CAD + MI/DM/heavy smoking). What is the treatment if LDL 100?
100 - meds + diet
List the major risk factors for coronary heart disease
- Age (men >45, women >55 or with premature menopause and no estrogen replacement)
- Family history (MI or sudden death in: father or 1st degree male relative 140/90 or on meds)
- Diabetes mellitus
- Low HDL 60 mg/dL is protective and negates one risk factor
How is LDL calculated?
LDL = total cholesterol - HDL - (triglycerides/5)
Describe the treatment of hypercholesterolemia
Give patients a few months to try lifestyle modifications
First line agents are HMG CoA reductase inhibitors (statins). Watch for rare but serious side effects of liver and muscle damage).
Second line agents include niacin (poorly tolerated but effects and RAISES HDL), ezetimibe (selectively inhibits intestinal absorption of cholesterol), and bile-acid resins (e.g. cholestyramine)
How is HDL affected by alcohol? Estrogens? Exercise? Smoking? Progesterone?
High HDL is protective against atherosclerosis and is increased by moderate alcohol consumption (1-2 drinks/day; but not by high alcohol intake), exercise, and estrogens.
HDL is decreased by smoking, androgens, progesterone, and hypertriglyceridemia.
What causes hypercholesterolemia?
Genetics play a role (e.g. familial hyperlipidemia) but most cases are multifactorial.
Western diet and inactive lifestyle contribute.
Also uncontrolled diabetes, hypothyroidism, uremia, nephrotic syndrome, obstructive liver disease, excessive alcohol intake (increases triglycerides), and medications (e.g. birth control pills, glucocorticoids, thiazides, beta blockers).
Why is cholesterol so important?
One of the main known modifiable risk factors for atherosclerosis.
Atherosclerosis is involved in 1/2 of all deaths in U.S. and 1/3 deaths between 36-65 y/o. Most important cause of permanent disability and accounts for more hospitals days than any other illness.
