Dyslipidemia

Gio, Lily, Liz, & Jessica

Dyslipidemia Pathophysiology
Dyslipidemia refers to a lipid profile that increases risk for
atheroscerotic development.
High (LDL) Low density lipoprotein
Low (HDL) High density lipoprotein

Dyslipidemia Pathophysiology continued

Different Types
Chylomicrons
VLDL
IDL
LDL
HDL

Dyslipidemia Pathophysiology continued

LDL
Transports cholesterol
cells
Oxidation
Contributes to initiation of atherosclerosis.

Dyslipidemia Pathophysiology continued

HDL

Protective effects against atherosclerosis.

Removes cholesterol and returns it to the liver.

cholesterol accumulation in plaques.

Who is at risk?
Individuals who:
Family History
Genetic
Obesity
Age & Sex
65 yrs. & males
Smoke
Physical Inactivity
Impaired Fasting Glucose

Common Diagnostic Test

Lipid Profile Test- Blood test from vein or a
fingerstick test can be done on a portable
device. (12 Hr Fast)
Total Cholesterol
HDL-C
LDL-C
Triglycerides

Pertinent Lab Findings of Lipid Profile

Test
Optimal

Near/Above
Optimal

Borderli
ne High

High

Very High

LDL

<100 mg/dL

100-129 mg/dL

130-159
mg/dL

160-189
mg/dL

> 190 mg/dL

Total
Cholesterol

<200 mg/dL

<200 mg/dL

200-239
mg/dL

240 mg/dL

Triglyceride

<150 mg/dL

150-199
mg/dL

200-499
mg/dL

HDL

500 mg/dL

High

Low

60 mg/dL

<40 mg/dL Men

<50 mg/dL Women

Treatments
Therapeutic Lifestyle Changes (TLC)
Drug therapy
Surgical approaches

Treatments
Goals depend on risk factors and risk score
Framingham Point Scores
Risk Factors

Age (>45 men, >55

women)
Family history of heart
disease
Smoking

Physical inactivity
High blood pressure
Overweight/Obesity
Diabetes

Treatment:
Therapeutic Lifestyle Changes
Patients w/ dyslipidemia start w/ TLC
National Cholesterol Education Program
Managed by National Heart, Lung, and Blood
Institute (NHLBI)
TLC Diet
Weight management
Physical activity

Therapeutic Lifestyle Changes

Change

LDL Reduction

Saturated fat

Decrease to less than

7% of calories

810%

Dietary cholesterol

Decrease to less
than 200 mg/day

35%

Soluble fiber

Add 510 grams/day

35%

Plant sterols/stanols

Add 2 grams/day

515%

Weight

Lose 10 pounds
if overweight

58%
Total

2030%*

Drug Therapy

Considered when
lipid results are high
lipid levels remained high after 6 months of TLC

Start w/ single-drug therapy

increase dosage if LDL goal is not met after 6 weeks
repeat another 6 weeks
after 12 weeks, LDL goal still not met?
Combination drug therapy

LDL Goals and Cutpoints for TLC and

Drug Therapy

Drugs Administered

HMG CoA Reductase Inhibitors (Statins)

Bile Acid Sequestrants (Resins)

Fibrates (Fibric Acid)

Niacin (Nicotinic Acid)
Cholesterol Absorption Inhibitors (Ezetimibe)

Surgical Approaches

Partial Ileal Bypass

Liver transplant
Severe cases of dyslipidemia, not manageable w/ TLC/drug
therapy
Familial Hypercholesterolemia
defective genes
Synthesis of LDL receptors (LDLR gene)
Functions of LDL receptors (APOB, LDLRAP1, PCSK9
genes)
Manipulates cholesterol absorption
lowers plasma cholesterol concentration

Surgical Approaches

Partial Ileal bypass

Side Effects
mild diarrhea
gas bloat syndrome
need for B12
supplements
increased incidence
of oxalate kidney
stones

Liver Transplant
Complications
blood clots
donated liver failure
infection
rejection of new liver
Side Effects
diarrhea
headaches
bone thinning
high blood pressure

Partial Ileal Bypass Surgery

DRUG THERAPY
Type/Class

LDL

HDL

TG

Contradictions

Adverse Effects

Statins

Decrease
dramatically

Increa
ses

Decrea
ses

Liver Disease

Myopathy
Increased transaminases

Bile Acid sequestrants

-Resins

Decreases

Slightl
y
increa
ses

No
effect
or
slightly
increas
es

Elevated TG

GI distress
Decreased absorption of other drugs

Nicotinic acid (alters

lipoprotein synthesis)

Decreases

Increa
ses

Decrea
ses

Severe liver
disease
Severe gout

Flushing Hyperglycemia
Gout, Hepatotoxicity

Fibric acid derivatives

Decreases

Increa
ses

Decrea
ses

Severe hepatic or
renal insufficiency

Dyspepsia GI Distress Cholesterol

Gallstones Myopathy

Cholesterol
absorption inhibitors

Decreases

No
chang
e

No
change

Statin
contraindications

Diarrhea, Upper respiratory tract

infection, Arthralgia

Statins(HMG CoA reductase inhibitor) Resins (Bile acid sequestrants)

Dramatically decrease LDL levels

Examples: lovastatin, pravastatin,

simvistatin, fluvastatin, atorvastatin,
rosuvastatin, pitavastatin

Decreases LDL, and slightly

increases HDL and decreases TG

Examples: cholestyramine, colestipol,

colesevelam

Nicotinic Acid

Fibrates

(Alters lipoprotein synthesis)

(Lower plasma lipids and TG levels)

Decreases LDL, TG, and increases HDL

Examples: Crystalline, time-release

Preparationsm Niaspan

Examples: Gemfibrozil Genofibrate

Clofibrate*

Cholesterol Absorption Inhibitor

Decreases LDL, but no effect on TG and HDL

Ezetimibe Zetia

Case Study
The patient is a 55 year old Hispanic male that is 69 tall, and weighs 215 lbs. with a BMI of 31.7. Three months ago he
weighed 195 lbs. His family history includes his father with HTN and his mother has diabetes mellitus. He does not
smoke and exercises twice a week. His breakfast consists of cereal with whole milk and a cup of coffee. He goes out to
dinner usually on the weekends and likes to order a good steak, hamburger, or occasionally fish. He orders out for lunch
with his company or takes out clients to lunch to restaurants. He cooks for himself at night. He usually makes pasta,
pizza, mexican dishes, or a sandwich. His lipid profile is as follows:
Total Cholesterol- 219 mg/dL
Triglycerides 330 mg/dL
HDL 44mg/dL
LDL 109 mg/dL

PES statements
1.
2.
3.

Excessive fat intake related to patient reporting high levels of saturated fat intake as evidenced by high Triglyceride
levels .
Excessive energy intake related to lack of daily caloric intake knowledge as evidenced by a BMI of 30.
Unintended weight gain related to eating out as evidenced by an increase of 20 pounds in 3 months.

Quiz
What is dyslipidemia usually characterized by?
a)

High LDL & Low HDL

b)

Low LDL & High HDL

c)

Both low LDL & HDL

What diet focuses on reducing fat, increasing physical activity, and increasing fruits, vegetables, and fiber?
a)

Weight Watchers

b)

Atkins Diet

c)

Therapeutic Lifestyle Changes

Identify which lab value is an optimal result for LDL?

a)

Less than 100 mg/dL

b)

Greater than 60 mg/dL

c)

Less than 170 mg/dL

References
Goldberg, A. (2013, October 1). Dyslipidemia. Retrieved February 11, 2015, from http://www.merckmanuals.
com/professional/endocrine_and_metabolic_disorders/lipid_disorders/dyslipidemia.html
Griffin, R. (2009, February 2). Plant Sterols and Stanols for Helping High Cholesterol. Retrieved February 10, 2015, from http:
//www.webmd.com/cholesterol-management/features/low-cholesterol-diet-plant-sterols-stanols
Heitz, D. (2014, January 6). Plasmapheresis. Retrieved February 10, 2015, from http://www.healthline.
com/health/plasmapheresis#Overview1
Kopin, L., & Goldmann, D. (2007). In the Clinic dyslipidemia. Annals of Internal, 9, 16-16. Retrieved January 24, 2105, from http:
//www.med.unc.edu/medselect/education/eduactivities/ITC Lipids article .full.pdf

References cont.
Lehrer, J. (2014, May 15). Liver transplant: MedlinePlus Medical Encyclopedia. Retrieved February 11, 2015, from http://www.
nlm.nih.gov/medlineplus/ency/article/003006.htm
Livertox-ANTILIPEMIC [LIPID-LOWERING] AGENTS. (2013, December 5). Retrieved February 1, 2015, from http://livertox.
nih.gov/Lipid-LoweringAgents.htm
National Cholesterol Education Program Slide Show. (2013, May 1). Retrieved February 11, 2015, from http://cvdrisk.nhlbi.nih.
gov/ncep_slds/menu.htm#4
Nelms, M., Sucher, K., (January 2015). Medical Nutrition Therapy: Cengage Learning. Pg. 308-311
Therapeutic Lifestyle Changes (TLC) Diet for High Cholesterol-Overview. (n.d.). Retrieved February 10, 2015, from http://www.
webmd.com/cholesterol-management/tc/therapeutic-lifestyle-changes-tlc-diet-for-high-cholesterol-