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DYSLIPIDEMIAI

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The plasma lipoproteins are divided into five major classes based on their relative density. - Each lipoprotein class comprises a family of particles that vary slightly in + Density + Size + Migration during electrophoresis + And protein composition. - Most plasma triglyceride is transported in chylomicrons or VLDLs, and most plasma cholesterol is carried as cholesteryl esters in LDLs and HDLs. II. SCREENING The NCEP ATPIII (Adult Treatment Panel (ATP) convened by the National Cholesterol Education Program (NCEP) of the National Heart Lung and Blood Institute ) guidelines published in 2001: all adults over age 20 should have plasma...

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DYSLIPIDEMIA I. LIPOPROTEINS - The plasma lipoproteins are divided into five major classes based on their relative density. - Each lipoprotein class comprises a family of particles that vary slightly in + Density + Size + Migration during electrophoresis + And protein composition.
- Most plasma triglyceride is transported in chylomicrons or VLDLs, and most plasma cholesterol is carried as cholesteryl esters in LDLs and HDLs. II. SCREENING The NCEP ATPIII (Adult Treatment Panel (ATP) convened by the National Cholesterol Education Program (NCEP) of the National Heart Lung and Blood Institute ) guidelines published in 2001: all adults over age 20 should have plasma levels of cholesterol, triglyceride, LDL-C, and HDL-C measured after a 12-hour overnight fast. III. DIAGNOSIS - Although many patients with hyperlipidemia have a primary or genetic cause of their lipid disorder, secondary factors frequently contribute to the hyperlipidemia. 1. A fasting glucose should be obtained in the initial work-up of all subjects with an elevated triglyceride level.
2. Nephrotic syndrome and chronic renal insufficiency should be exc luded by obtaining urine protein and serum creatinine. 3. Liver function tests should be performed to rule out hepatitis and cholestasis. 4. Hypothyroidism should be ruled out by measuring serum TSH. - Patients with hyperlipidemia, especially hypertriglyceridemia, who drink alcohol or are obese should be encouraged to decrease their intake. Sedentary lifestyle, obesity, and smoking are all associated with low HDL-C levels, and patients should be counseled about these issues. - Once secondary causes for the elevated lipoprotein levels have been ruled out, attempts should be made to diagnose the primary lipid disorder since the underlying etiology has a significant effect on the risk of developing CHD, on the response to drug therapy, and on the management of other family members. Often, determining the correct diagnosis requires a detailed family medical history and, in some cases, lipid analyses in family members. IV. NONPHARMACOLOGIC TREATMENT Diet: An important component in the management of dyslipidemi a. - elevated LDL-C, dietary saturated fat and cholesterol should be restricted. - hypertriglyceridemia, the intake of simple carbohydrates should be curtailed. - severe hypertriglyceridemia (>1000 mg/dL), restriction of total fat intake is critical.
The most widely used diet to lower the LDL-C level is the "Step I diet" developed by the American Heart Association. Most patients have a relatively modest (