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Familial hypercholesterolemia
- Lack of or faulty LDL receptors leading to increased LDL crculating in blood that never gets taken back to liver. The Apo B protein starts interacting at the vessel wall leading to atherosclerosis.
- Cholesterol - 700-1000
- Triglycerides - normal
- Xanthelasmas, corneal arcus, xanthomas
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Familial hyperlipidemia
- Lipoprotein lipase deficiency - associated with metabolic syndrome
- Increased LDL and Apo B.
- Mixed elavation in triglycerides & LDLs with low HDL
- Responds to diet & exercise but most need meds
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Chylomicron syndrome
- At increased risk for this if pt has familial hypertriglyceridemia.
- Signs - abdominal pain, hepatosplenomegaly, eruptive xanthomas, pancreatitis, lipemia retinalis, paresthesias.
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Statins
- lowers LDL, increased HDL & lowers triglycerides
- Gold standard for cholesterol trx
- Can get rhabdomyolysis so if pt c/o achy joints, take them off.
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Nicotinic acid - Niacin
- Vitamin B3 - lowers triglycerides, increases HDL and modestly lowers LDL.
- Can get flushing, intensity can be diminished with aspirin
- Can be used w/ simvastatin to induce plaque regression
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Fibrates - Gemfibrizol, Fenofibrate
- Effective at lowering triglycerides in pts w/ very high levels who are at risk for pancreatitis, esp. in those who can't tolerate Niacin. Tends to increase LDLs in pts.
- Monitor CPKs and LFTs
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Cholesterol absorption inhibitors - Ezetimibe
- Lowers both LDL and triglycerides with minimal effects on HDL. Can be used in combination with statin to further lower LDL.
- Can get hepatitis, abdominal pain, arthralgia
- Monitor LFTs and CPK
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Bile acid sequestrants - cholestyramine
- Lower LDL & decrease cardiovascular event rates. Especially effective when combined with statins
- GI side effects, decreased absorption of some drugs (BC)
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Other meds
Fiber (metamucil), fish oil, diet & exercise.
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