Dyslipidemia

Question 1

define dyslipidemia

Answer 1

metabolic disorder characterized by elevations of fasting plasma cholesterol and/or triglycerides and/or low HDL

hypercholesterolemia is the presence of an increased amount of cholesterol most commonly increased LDL in the blood

Question 2

what are the primary vs. secondary causes of dyslipidemia

Answer 2

primary–> genetic causes like familial hypercholesterolemia, familial combined hyperlipidemia

secondary--> 
obesity/metabolic syndrome
diet
alcohol--elevated TGs
DM
hypothyroid
chronic liver disease
monoclonal gammopathy
drug induced

Question 3

what should you focus on in the history for dyslipidemia

Answer 3

risk factors and causes

Question 4

what are the risk factors and causes of dyslipidemia

Answer 4

age

diet high in saturated fats and cholesterol i.e dairy, animal fat, organ and/or alcohol

sedentary lifestyle

obesity

family history, including early MI

smoking

symptoms of CAD or PVD

associated diseases

pregnancy

associated drugs

Question 5

symptoms of CAD

Answer 5

chest, neck, arm, back pain

diaphoresis

SOB

Question 6

symptoms of PVD

Answer 6

claudication

rest pain

Question 7

what are diseases associated with dyslipidemia

Answer 7

hypothyroidism

DM

chronic renal failure

obstructive liver disease

Question 8

what are some drugs associated with dyslipidemia

Answer 8

thiazides

beta blockers

steroids

cyclosporine

retinoic acid derivatives

Question 9

what to look for on physical exam for dyslipidemia

Answer 9

weight

BP

xanthomas

look at fundi

thyroid exam for goiter and for peripheral signs

precordial exam (for LVH)

peripheral bruits, peripheral pulses, dependent rubor

skin for ulcers, indurations, hair loss for PVD

hepatosplenomegaly, scleral icterus, palmar erythema for liver disease

Question 10

what does an exam for dyslipidemia focus on

Answer 10

signs of hypercholesterolemia or associated diseases

Question 11

where do you look for xanthomas

Answer 11

eye lids

knuckles

tendons

skin creases

Question 12

why do you look at the fundi in exam for dyslipidemia

Answer 12

signs of HTN, DM

Question 13

what lab tests should you order in dyslipidemia

Answer 13

fasting lipoprotein analysis –gives total cholesterol, HDL, LDL and TGs

plus anything else related to an associated disease if the hx or exam was suggestive of one

Question 14

what tool can you use to calculate CV risk in dyslipidemia

Answer 14

framingham tool

gives targets for lowering cholesterol (LDL and ratio) depending on these scores

Question 15

what are some conservative/lifestyle changes to manage dyslipidemia

Answer 15

trial for 3-6 months before meds unless high risk

smoking cessation

diet

exercise

reduced alcohol

Question 16

what medications can be used for dyslipidemia

Answer 16

statins

resins

fibrates

Question 17

what are statins and how do they work

Answer 17

HMG-CoA reductase inhibitors

slowls cholesterol synthesis and therefore decreases LDL

ie atorvastatin

Question 18

what are resins and how do they work

Answer 18

bile acid sequestrants

bind bile acids in the intestinal lumen and therefore decrease LDL

i.e cholestyramine

Question 19

what are fibrates and how do they work

Answer 19

decrease TGs and increase HDL and decrease LDL

i.e gemfibrozil

Question 20

other than statins, resins and fibrates, what medications may be considered in the setting of dyslipidemia

Answer 20

risk reduction meds like ASA