1. 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
  2. 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
  3. Chylomicron syndrome
    • At increased risk for this if pt has familial hypertriglyceridemia.
    • Signs - abdominal pain, hepatosplenomegaly, eruptive xanthomas, pancreatitis, lipemia retinalis, paresthesias.
  4. LDL goal
  5. 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.
  6. 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
  7. 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
  8. 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
  9. 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)
  10. Other meds
    Fiber (metamucil), fish oil, diet & exercise.
Card Set