2. OBJECTIVES
By the end of this session you will be able to know:
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Epidemiology
Classifications
Diagnosis
Screening
Management
3. Introduction
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Dyslipidemia?
Is a metabolic disorders defined as elevated total
or low-density lipoprotein (LDL) cholesterol levels,
or low levels of high-density lipoprotein (HDL)
cholesterol
Is an important risk factor for coronary heart
disease (CHD) and stroke
4. ▪ A recent study done in 2012, demonstrated the
prevalence of dyslipidemia among adults in the
KSA ranges from 20% to 44%,
Abdulaziz F. Al-Kaabba et al "Prevalence and Correlates of Dyslipidemia
among Adults in Saudi Arabia: Results from a National Survey," Open Journal
of Endocrine and Metabolic Diseases, Vol. 2 No. 4, 2012, pp. 89-97.
12. 10 year risk of ASCVD
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ASCVD app:
low risk <5%
intermediate risk 5-7.5%
high risk ≥7.5%
13. Clinical ASCVD
▪ Clinical ASCVD is defined by the inclusion criteria for
the secondary prevention statin RCTs:
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2.
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5.
Acute coronary syndromes
History of MI
Stable or unstable angina
Coronary or other arterial revascularization
Stroke, TIA, or peripheral arterial disease presumed
to be of atherosclerotic origin)
14. New ATP IV Guidelines
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Focus on ASCVD risk reduction
Classified into 4 statin benefit groups:
Individuals with clinical ASCVD
Individuals with primary elevation of LDL–C > 190
mg/dl
Individuals 40 - 75 years of age with diabetes type 1 or 2 .
Individuals without (clinical ASCVD or diabetes),
who are 40 – 75 years of age with LDL-C 70-189
mg/dl and an estimated 10 year ASCVD risk of 7.5 %
or higher.
20. Statin intolerance
❖ It is reasonable to evaluate and treat muscle symptoms, including
pain, tenderness, stiffness, cramping, weakness, or fatigue, in statin-
treated patients according to the following management algorithm:
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To avoid unnecessary discontinuation of statins, obtain a history of prior or
current muscle symptoms to establish a baseline before initiating statin
therapy.
If unexplained severe muscle symptoms or fatigue develop during statin
therapy, promptly discontinue the statin and address the possibility of
rhabdomyolysis by evaluating CK, creatinine, and a urinalysis for
myoglobinuria.
21. Statin intolerance
❖ If mild to moderate muscle symptoms develop during
statin therapy:
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Discontinue the statin until the symptoms can be
evaluated.
Evaluate the patient for other conditions that might
increase the risk for muscle symptoms (e.g.,
hypothyroidism, reduced renal or hepatic function,
rheumatologic disorders such as polymyalgia rheumatica,
steroid myopathy, vitamin D deficiency, or primary muscle
diseases.)
If muscle symptoms resolved, and if no contraindication
exists, give the patient the original or a lower dose of the
same statin to establish relationship between the muscle
symptoms and statin therapy.
22. Statin intolerance
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If a relationship exists, discontinue the original statin.
Once muscle symptoms resolve, use a low dose of a
different statin.
Once a low dose of a statin is tolerated, gradually
increase the dose as tolerated.
If, after 2 months without statin treatment, muscle
symptoms or elevated CK levels do not resolve
completely, consider other causes of muscle symptoms
listed above.
If persistent muscle symptoms are determined to arise
from a condition unrelated to statin therapy, or if the
predisposing condition has been treated, resume statin
therapy at the original dose.
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In many large studies, elevated TG were determined to be independent
risk factor for CAD.
When triglycerides are 200 mg/dL or greater but less than 500 mg/dL, a
non–HDL-C calculation will provide better risk assessment than LDL-C alone
Rule out secondary causes and Manage them:
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Obesity.
DM.
Nephrotic syndrome.
Hypothyroidism.
Estrogen replacement.
Beta blockers.
Medications (Glucocorticoids, cyclosporin)
Hypertriglyceridemia
