Hypercholesterolemia

Aka: Hypercholesterolemia, Hyperlipidemia

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II. General

  1. Coronary Artery Disease Risk Factors
    1. Positive Risk Factors
      1. See Cardiac Risk Factors
    2. Negative Risk Factors (Protective)
      1. HDL Cholesterol over 60 mg/dl
  2. Available lipid lowering modalities
    1. Dietary changes
      1. Low Fat Diet
      2. Phytosterols (Plant Stanols) lower LDL Cholesterol
    2. Weight loss for Obesity
      1. Lowers LDL Cholesterol
      2. Improves Insulin sensitivity
    3. Aerobic Exercise
      1. Raises HDL Cholesterol
      2. Lowers Triglycerides
    4. Anti-hyperlipidemic Medications
    5. Tobacco Cessation (Increases HDL by 30%)

III. Causes: Secondary Causes of Hypercholesterolemia

  1. Genetic Cholesterol disorder
    1. LDL Cholesterol > 200 mg/dl
    2. Triglycerides > 1000 mg/dl
    3. HDL Cholesterol < 30 mg/dl
  2. Hypothyroidism
  3. Nephrotic Syndrome
  4. Chronic Liver Disease (primary biliary Cirrhosis)
  5. Dysglobulinemia
  6. Cushing's Syndrome
  7. Hyperparathyroidism
  8. Acute Intermittent Porphyria
  9. Medications
    1. Protease Inhibitors

IV. Screening: Guidelines

  1. General counseling for all patients
    1. Low Fat Diet
    2. Exercise Program
  2. Criteria for age to start screening
    1. NIH as of 2011 recommends screening all ages 9-11 and again at 17-21years
      1. Treat patients only with significant LDL increase (e.g. >190)
    2. Age over 20 years (ATP III Guidelines)
      1. Screen at age 20 and then every 5 years
      2. Prior guidelines for age to start screening
        1. Age >34 years in men
        2. Age >44 years in women
    3. Ages 2 to 20 years
      1. Family History of Total Cholesterol >300 mg/dl
      2. Family History Premature Coronary Artery Disease
        1. Age under 56 years in men
        2. Age under 66 years in women
  3. Screening protocol (repeated every 5 years)
    1. Full Fasting lipid profile preferred (ATP III guide)
    2. Alternative protocol: Non-Fasting lipid screening
      1. NCEP reasoning for non-Fasting lipid screening
        1. Non-Fasting screening improves compliance
        2. Postprandial Triglyceride rise can be evaluated
          1. Related to atherosclerosis risk
      2. Protocol
        1. Obtain non-Fasting Total Cholesterol with HDL
      3. Criteria to perform Fasting full lipid panel
        1. No Cardiac Risk Factors: Cholesterol >240 mg/dl
        2. Cardiac Risk Factors: Cholesterol >200 mg/dl
        3. HDL Cholesterol <40 mg/dl
    3. Alternative protocol: Non-Fasting Non-HDL Cholesterol
      1. Non-HDL Cholesterol = VLDL + IDL + LDL
      2. Correlates very well with outcomes
      3. Convenient (Patient does not need to fast)
      4. Goal Non-HDL Cholesterol is 30 higher than LDL goal

V. Evaluation: Framingham Risk Score (FRS)

  1. http://www.nhlbi.nih.gov/about/framingham/riskabs.htm
  2. NCEP Framingham Online Calculator
    1. http://hin.nhlbi.nih.gov/atpiii/calculator.asp
  3. Results of lowering LDL Cholesterol
    1. Relative CAD risk reduced 1% per 1% LDL decrease

VI. Management: Medication Management

  1. See Hyperlipidemia Management

VII. Management: Less than two Cardiac Risk Factors

  1. Cholesterol Management
    1. Goal if LDL Cholesterol below 160 mg/dl (ideally <130)
    2. Low Fat Diet if LDL Cholesterol over 160 mg/dl
    3. Anti-hyperlipidemic if LDL Cholesterol over 190 mg/dl
  2. Monitoring
    1. Desirable lipids: Repeat Lipid panel in 5 years
    2. Borderline lipids: Repeat lipid panel in 1 year
    3. Elevated lipids: Repeat lipid panel in 3-6 months

VIII. Management: Two or more Cardiac Risk Factors

  1. Cholesterol Management
    1. Goal LDL Cholesterol below 130 mg/dl
    2. Low Fat Diet if LDL Cholesterol over 130 mg/dl
    3. Anti-hyperlipidemic indications
      1. LDL Cholesterol over 130 (FRS 10 year risk <20%)
      2. LDL Cholesterol over 160 (FRS 10 year risk <10%)
  2. Monitoring
    1. Desirable lipids: Repeat Lipid panel in 1-2 years
    2. Borderline lipids: Repeat lipid panel in 6 months
    3. Elevated lipids: Repeat lipid panel in 2-3 months

IX. Management: Coronary Artery Disease or equivalent

  1. Coronary Artery Disease equivalents
    1. Diabetes Mellitus
    2. Ten year Framingham Risk Score (FRS) 20% or higher
    3. Abdominal Aortic Aneurysm
    4. Peripheral Vascular Disease (e.g. Claudication)
    5. Symptomatic Carotid Artery disease
  2. Cholesterol Management
    1. Goal LDL Cholesterol below 100 (ideally <70 mg/dl)
    2. Low Fat Diet if LDL Cholesterol above 100 mg/dl
    3. Anti-hyperlipidemic if LDL Cholesterol over 130 mg/dl
  3. Monitoring
    1. Desirable lipids: Repeat Lipid panel in 6-12 months
    2. Borderline lipids: Repeat lipid panel in 2-3 months
    3. Elevated lipids: Repeat lipid panel in 6 weeks

X. Management: CAD with multiple uncontrolled risks

  1. Goal LDL Cholesterol below 70 mg/dl
  2. Low Fat Diet if LDL Cholesterol above 70 mg/dl
  3. Anti-hyperlipidemic if LDL Cholesterol over 100 mg/dl

XI. References

  1. (2001) JAMA 285:2486-97 [PubMed]
  2. Ahmed (1998) Am Fam Physician 57(9):2192-203 [PubMed]
  3. Grundy (1997) Circulation 95:2329-31 [PubMed]
  4. Grundy (1997) Am Fam Physician 55(6): 2250-8 [PubMed]
  5. Mosca (2002) Am Fam Physician 65(2):217-26 [PubMed]
  6. Safeer (2002) Am Fam Physician 65(5):871-80 [PubMed]
  7. Yeshuran (1995) South Med J 88:379-91 [PubMed]

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Related Studies

Ontology: Hypercholesterolemia (C0020443)

Definition (CSP) abnormally high levels of cholesterol in the blood.
Definition (MSH) A condition with abnormally high levels of CHOLESTEROL in the blood. It is defined as a cholesterol value exceeding the 95th percentile for the population.
Concepts Disease or Syndrome (T047)
MSH D006937
SnomedCT 267500001, 154740003, 13644009
LNC LA14292-9
English Hypercholesteremia, Hypercholesteremias, Hypercholesterolemias, HYPERCHOLESTEROLAEMIA, HYPERCHOLESTEROLEMIA, hypercholesteremia, hypercholesterolemia, hypercholesterolemia (diagnosis), Elevated cholesterol, Hypercholesterolemia [Disease/Finding], Hypercholesterolemia, elevated cholesterol, high blood cholesterol level, hypercholesteraemia, Elevated Cholesterol, Hypercholesteraemia, Hypercholesterolaemia, Hypercholesterolemia (disorder), Hypercholesterolemia, NOS, Hypercholesterolaemia, NOS, hypercholesterolaemia
French HYPERCHOLESTEROLEMIE, Hypercholestérémie, Hypercholestérolémies, Hypercholestérolémie
Portuguese HIPERCOLESTEROLEMIA, Colesterol elevado, Hipercolesterolemia, Hipercolesteremia
Spanish HIPERCOLESTEROLEMIA, hipercolesterolemia (trastorno), hipercolesterolemia, Elevación del colesterol, Hipercolesterolemia, Hipercolesteremia
German HYPERCHOLESTERINAEMIE, Hypercholesterolemie, Hypercholesteraemie, Hypercholesterinaemie, Erhoehtes Cholesterin, Hypercholesterinaemia, Hypercholesterinämie
Italian Colesterolo elevato, Ipercolesterolemia
Dutch hypercholesteremie, hypercholesterolemie, verhoogd cholesterol, Cholesterolemie, hyper-, Hypercholesterolemie
Japanese コレステロール上昇, ｺﾚｽﾃﾛｰﾙｼﾞｮｳｼｮｳ, ｺｳｺﾚｽﾃﾛｰﾙｹﾂｼｮｳ, ｺｳｺﾚｽﾃﾛｰﾙｹｯｼｮｳ, 高コレステリン血症, 高コレステロール血症, コレステリン血, コレステリン血症, コレステロール過剰血, コレステロール過剰血症, 高β-リポ蛋白血, 高β-リポ蛋白血症, 高コレステリン血, 高コレステロール血, 高βリポタンパク血症, 高βリポ蛋白血症, 高ベータリポタンパク血症, 高ベータリポ蛋白血症
Swedish Hyperkolesterolemi
Czech hypercholesterolémie, Zvýšený cholesterol, Hypercholesterolemie, vysoký cholesterol
Finnish Hyperkolesterolemia
Russian GIPERKHOLESTERINEMIIA, KHOLESTERINEMIIA, ГИПЕРХОЛЕСТЕРИНЕМИЯ, ХОЛЕСТЕРИНЕМИЯ
Croatian HIPERKOLESTEROLEMIJA
Polish Hipercholesterolemia, Hipercholesteremia
Hungarian Hypercholesteraemia, Hypercholesterinaemia, Megemelkedett koleszterin
Norwegian Hyperkolesterolemi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hyperlipidemia (C0020473)

Definition (NCI) Elevated levels of lipids in the blood.
Definition (CSP) excess of lipids in the blood.
Definition (MSH) Conditions with excess LIPIDS in the blood.
Concepts Disease or Syndrome (T047)
MSH D006949
ICD10 E78.5
SnomedCT 154743001, 190782002, 154739000, 267499005, 55822004
English Hyperlipemia, Hyperlipemias, HYPERLIPAEMIA, Hyperlipidaemia NOS, Hyperlipidaemia, unspecified, Hyperlipidemia, unspecified, Hyperlipidemias, Hyperlipidemia NOS, hyperlipemia, hyperlipidemia (diagnosis), hyperlipidemia, Hyperlipaemia, Hyperlipidemias [Disease/Finding], lipidaemia, excessive fat in the blood, hyperlipidaemias, hyperlipidemias, lipidemia, Hyperlipidaemia NOS (disorder), Hyperlipidemia NOS (disorder), Disorder characterized by hyperlipidemia, Hyperlipidaemia, Lipidemia, HLD - Hyperlipidaemia, HLD - Hyperlipidemia, Hyperlipidemia (disorder), Lipidaemia, lipemia, lipoidemia, Hyperlipidemia, NOS, Hyperlipidaemia, NOS, Hyperlipidemia, hyperlipidaemia
Portuguese HIPERLIPEMIA, Hiperlipidemia NE, Hiperlipidemias, Hiperlipidemia, Hiperlipemia
Spanish HIPERLIPEMIA, Hiperlipidemia NEOM, Hiperlipidemias, hiperlipidemia, SAI (trastorno), hiperlipidemia, SAI, Hyperlipidaemia NOS, Hyperlipidemia NOS, hiperlipemia, hiperlipidemia (trastorno), hiperlipidemia, Hiperlipidemia, Hiperlipemia
Dutch hyperlipemie, hyperlipidemie NAO, Hyperlipidemie, niet gespecificeerd, hyperlipidemie
French Hyperlipidémie SAI, Hyperlipidémie, HYPERLIPEMIE, Hyperlipémies, Hyperlipidémies, Hyperlipémie
German Hyperlipaemie, Hyperlipidaemie NNB, HYPERLIPAEMIE, Hyperlipidaemie, nicht naeher bezeichnet, Hyperlipidaemie, Hyperlipämie, Hyperlipidämie
Italian Iperlipidemia NAS, Condizione iperlipidemica, Lipidi elevati, Valori lipidici elevati, Iperlipidemia, Iperlipemia
Russian ГИПЕРЛИПИДЕМИИ, GIPERLIPEMIIA, GIPERLIPIDEMII, LIPEMIIA, ГИПЕРЛИПЕМИЯ, ЛИПЕМИЯ
Japanese 高脂血症ＮＯＳ, ｺｳｼｹｯｼｮｳNOS, ｺｳｼｹｯｼｮｳ, ｺｳｼｹﾂｼｮｳNOS, ｺｳｼｹﾂｼｮｳ, 高脂質血, 高脂血症, 脂血症, 脂肪過剰血, 脂質過剰血症, 脂肪血症, 高脂肪血症, リポイド過多血症, 高脂血症(コウシケツショウ), 脂質異常症, 高脂質血症
Swedish Hyperlipemier
Czech hyperlipémie, hyperlipidémie, Hyperlipidemie NOS, Hyperlipemie, Hyperlipidemie
Finnish Hyperlipidemiat
Korean 상세불명의 고지혈증
Croatian HIPERLIPIDEMIJA
Polish Hiperlipidemia samoistna rodzinna, Hiperlipidemie
Hungarian Hyperlipidaemia, Hyperlipaemia, Hyperlipidaemia k.m.n.
Norwegian Høyt blodfett, Hyperlipidemier, Hyperlipemi, Hyperlipidemi
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Hyperlipidemia

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