Depart.

Of Pharmacology & Therapy

Medical Faculty Padjadjaran University
Dr. Rovina Ruslami SpPD
Atherosclerosis complications :
IMA


stroke
PVD
50% of death in USA
Angina, Heart Failure
TIA
Claudicatio intermitten
Quality of life
Atherosclerosis hyperlipidemia
Coronary artery disease
(= CAD )
Cholesterol and Relative CAD Risk
4
3
2
1
0
C
A
D

r
i
s
k

r
a
t
i
o

0.7
100 150 200 250 300
mg/dl
Plasma Cholesterol
1
2
4
environment influences
Hyperlipidemia
Plasma cholesterol & TG level > optimal level
genetic disorders
dietary

drug therapy
combination
hydrophobic
Lipid :
lipoprotein
Core (non polar) : CE, TG
Surface (polar ) : PL, fC, apo
1. Chylomicron
2. VLDL
3. IDL
4. LDL
5. HDL
6. Lp(a)
density

TG
Endogenous TG
Chol + TG
Chol
Chol + PL
Chol
Major lipid
Endogenous system
Exogenous system
Causes of Hyperlipidemia :
Primary : genetic disorder
Secondary :
diabetes
NS
uremia
hypothyroidism
oral contraceptive
- blocker
icterus obstructive
alcohol
Hyperlipidemia - Atherosclerosis
1. Researchers
(from animals,lab.
invest, epidemiology,
genetics)
Elevated LDL-cholesterol
Major cause of CAD
2. LDL-lowering therapy Risk for CAD
Primary target of
cholesterol lowering therapy
LDL-chol.
Approach for Management of Hyperlipidemia
Evaluation of Hypercholesterolemia(NCEP guidelines)

T- cholesterol
< 200 < 130 optimal
< 100

200 239 130-159 N- high


240 > 160 High
LDL class risk fct follow up
- 5 years
+ diet, evaluation
- diet, annual check
+ diet, drug, annual check
- diet, drug (LDL>190)
+ diet & drug th/
Treatment of Hypercholesterolemia

ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dl)
LDL cholesterol
< 100 Optimal
100 129 Near or above optimal
130 159 Borderline high
160 189 High
190 Very high
Total cholesterol
< 200 Desirable
200 239 Borderline high
240 High
HDL cholesterol
< 40 Low
60 High