2. Dyslipidemias are disorders of lipoprotein metabolism, including lipoprotein
overproduction or deficiency. These disorders may be manifested by elevation of the
serum total cholesterol, LDL and triglyceride concentrations and a decrease in HDL
cholesterol concentration.
Various lipoproteins:
3. • Transport dietary lipids from intestine
to liver (exogenous)
• Transport lipids from liver to peripheral
tissues (endogenous)
• Cholesterol is a waxy substance
produced and released by cells in the
liver.
• The body uses cholesterol to form cell
membranes, aid in digestion, convert
Vitamin D in the skin and
develop hormones.
• Lipoproteins form a package for the
cholesterol:
• Low density lipoproteins (LDL)
• High density lipoproteins (HDL)
7. Screening
• Lipid profile
• HDL
• Triglyceride
• Calculated LDL-C
• Fredrickson classification , particle size, c-
reactive protein
• Ankle brachial index less than 0.9
• Apo lipoprotein B more than 130mg/dl
• Framingham risk score
8.
9. Lipid association of India
• Indian expert consensus document on management of
dyslipidemia in Indians.
• Compared with the western populations, Indians tend to
have higher triglyceride levels and lower HDL-C but the
total cholestrol and LDL-C levels are generally lower.
• Indians have high prevalence of diabetes, obesity and
metabolic syndrome, all of which are characterised by high
TG levels, low HDL-C and higher prevalence of small
dense LDL particles, which is also known as atherogenic
dyslipidemia.
• Among various lipid markers, the ratio of apolipoprotein B
to apolipoprotein A-1 appears to be the best indicator of
ASCVD risk.
15. COVID-19
• There is scarcity of evidence regarding the efficacy and
risk of different strategies in patients with COVID-19
disease.
• COVID-19 disease may trigger destabilisation of
chronic CVD.
• Aspirin dosage given for the secondary prevention of
atherothrombosis has no anti-inflammatory potential
and there should not be interrupted in COVID-19
patients without any other relevant reasons.
• Anti- viral therapy, it is of major importance to correct
modifiable predisposing factors.
17. Advances in the management of
dyslipidemia
• PCSK9-I
• PCSK9 inhibition by Monoclonal antibodies
• Evolocumab or Alirocumab are second line treatments for hyperlipidaemia.
• Human monoclonal antibodies; PCSK9 inhibitors can be given (140 mg injection every 2 weeks )
• when LDL is persistently above the thresholds despite maximal tolerated lipid-lowering therapy.
• Binding of LDL with PCSK9 leads to degradation of the LDL receptor, and then less LDL is removed
from the circulation.
• Inhibiting PCSK9 from being degraded therefore promotes removal of LDL cholesterol from
circulation
• After subcutaneous administration of alirocumab, maximal suppression of free PCSK9 occurs within 4
to 8 hours.
• Inclisiran
• Ethyl ester of eicosapentaenoic acid