III Dyslipidemia

III Dyslipidemia - III LABORATORYDIAGNOSIS OFDYSLIPIDEMIA

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III  LABORATORY DIAGNOSIS  OF DYSLIPIDEMIA Laboratory Medicine (SPPS 216)
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OBJECTIVES To understand the current National  Cholesterol Education Program guidelines To understand risk related target goals To be able to describe the various sources  of lipids To understand how the laboratory is used  to monitor drug therapy   
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KEY TERMS  Chylomicron Dyslipidemia HDL IDL LDL Lipid Lipoprotein NCEP Triglycerides VLDL
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March 30, 2009 Statins reduce blood clot risk, study indicates Medicines may also benefit people with low cholesterol For the study, researchers in the United States and two dozen other countries  randomly assigned 17,802 people with high CRP and low levels of LDL, or  bad cholesterol (below 130), to take dummy pills or Crestor, a statin made by  British-based AstraZeneca.  With an average of two years of follow-up, 34 of those on Crestor and 60 of  the others developed venous thromboembolism – a blood clot in the leg that  can travel to the lungs. Several hundred thousand Americans develop such  clots each year, leading to about 100,000 deaths. 
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Exogenous Pathway TG, triglyceride; CE, cholesterol ester; FC, free cholesterol; PL, phospholipids; FA, fatty acids; LPL, lipoprotein lipase; B, apolipoprotein B-48; A, apoliprotein A-I; C, apoliprotein C-II; E, apoliprotein E
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Endogenous Lipoprotein  Metabolism IDL, intermediate-density lipoprotein; LCAT, lecithin cholesterol acyltransferase; B, apoliprotein B-100; E, apoliprotein E
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Major Lipids and Protein  Components Variable Chylomicron VLDL IDL LDL HDL Major lipids TG TG TG, CE CE Phospholipids Major proteins AI, B-48, CI-CIII B-100, CI-CIII, E B-100, E B-100 AI, AII
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LDL Cholesterol Total Cholesterol HDL Cholesterol < 100 Optimal < 200 Desirable < 40 Low 100-129 Near optimal 200-239 Borderline high > 60 High 130-159 Borderline 240 High 160-189 High 190 Very high Adult Classifications of LDL, Total and  HDL Cholesterol (mg/dL) 
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NCEP Guidelines Risk assessment-measure LDL (20 y.o.)  every 5 years Clinical judgment takes precedence  Dietary lowering of LDL as good as drugs,  with their respective degree of cholesterol  lowering The determining factor for the lower risk cut  point for drug recommendation is cost  effectiveness  
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Laboratory Assessment of  Hyperlipidemia  Total cholesterol and HDL- fasting or non-fasting
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III Dyslipidemia - III LABORATORYDIAGNOSIS OFDYSLIPIDEMIA

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