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Dyslipidemia Fall 2012 (1)

Atherosclerosis

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Atherosclerosis http://healthhabits.files.wordpress.com/2009/08/atherosclerosis.jpg   http://www.web-books.com/eLibrary/Medicine/Cardiovascular/Images/Athero.gif   
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Complications of Atherosclerosis Atherosclerosis Peripheral  arterial  disease CHD Cerebrovascular  disease Myocardial  infarction Angina Sudden  death Heart failure Arrhythmias
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Screening for Dyslipidemia Primary prevention Every 5 years if   20 years old and no known  CVD or diabetes Secondary prevention Annually if known atherosclerosis or diabetes
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Cholesterol Testing Non-fasting Fasting lipid panel (FLP) Direct LDL (LDL-C)
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Total Cholesterol TC = HDL + LDL + (TG/5) Calculated LDL*:   LDL = TC – [HDL + (TG/5)] OR LDL = TC – HDL – (TG/5) * These numbers are only accurate when TG < 400 mg/dL
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Lipid Panel Assessment TC < 200 mg/dL Desirable LDL Based on CVD risk factors HDL Men: < 40 mg/dL Low Women: < 50 mg/dL >  60 mg/dL Ideal TG < 150 mg/dL Desirable >  500 mg/dL Very high
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Patient Specific Assessment Assess patient specific CVD risk Determine therapy target (s) Evaluate modifiable risk factors Rule out secondary causes of  dyslipidemia
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CVD Risk Factor Assessment 1. Age Men   45 Women   55 1. Family history of premature CHD Men   55 Women   65 1. Cigarette smoking 2. Hypertension BP   140/90 mm Hg or on medication 1. Low HDL-C (< 40 mg/dL) High HDL-C is a  NEGATIVE  risk factor (  60 mg/dL) National Cholesterol Education Program’s Expert Panel on Detection, Evaluation, and Treatment of  High Blood Cholesterol in Adults, Adult Treatment Panel III. NCEP ATP III Update. Circulation. 2004.
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Determine CVD Risk Category Lower  Lower  Risk 0 to 1 CV risk factors 0 to 1 CV risk factors Moderate Risk Moderate Risk 2 CV risk factors and  10-yr risk <10% Moderately Moderately- high Risk high Risk 2 CV risk factors and  10-yr risk 10-20% Very Very- high Risk high Risk High Risk High Risk Framingham  Framingham  10 10 - year CHD risk year CHD risk 10% 10% 20% 20%
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Risk categories Lower risk Patients with 0-1 risk factors 10-year risk of CHD is likely < 10% No Framingham risk score needed Moderate and moderately high risk Patients with   2 risk factors and no CVD or risk  equivalent Calculate 10-year Framingham risk score Moderate risk if < 10% Moderately high risk if 10-20%
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High risk No Framingham risk score needed Patients with CHD:   MI, angina, cardiac surgery CHD risk equivalent: Non-coronary atherosclerotic vascular disease Abdominal aortic aneurism (AAA) Peripheral arterial disease (PAD) Diabetes Patients with   2 risk factors  and a 10-year  Framingham risk score > 20% Risk categories
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Risk categories Very high risk  
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