II. General
-
Coronary Artery Disease Risk Factors
- Positive Risk Factors
- See Cardiac Risk Factors
- Negative Risk Factors (Protective)
- HDL Cholesterol over 60 mg/dl
- Positive Risk Factors
- Available lipid lowering modalities
- Dietary changes
- Low Fat Diet
- Phytosterols (Plant Stanols) lower LDL Cholesterol
- Weight loss for Obesity
- Lowers LDL Cholesterol
- Improves Insulin sensitivity
- Aerobic Exercise
- Raises HDL Cholesterol
- Lowers Triglycerides
- Anti-hyperlipidemic Medications
- Tobacco Cessation (Increases HDL by 30%)
- Dietary changes
III. Causes: Secondary Causes of Hypercholesterolemia
-
Genetic Cholesterol disorder
- LDL Cholesterol > 200 mg/dl
- Triglycerides > 1000 mg/dl
- HDL Cholesterol < 30 mg/dl
- Hypothyroidism
- Nephrotic Syndrome
- Chronic Liver Disease (primary biliary Cirrhosis)
- Dysglobulinemia
- Cushing's Syndrome
- Hyperparathyroidism
- Acute Intermittent Porphyria
- Medications
IV. Screening: Guidelines
-
General counseling for all patients
- Low Fat Diet
- Exercise Program
- Criteria for age to start screening
- NIH as of 2011 recommends screening all ages 9-11 and again at 17-21years
- Treat patients only with significant LDL increase (e.g. >190)
- Age over 20 years (ATP III Guidelines)
- Screen at age 20 and then every 5 years
- Prior guidelines for age to start screening
- Age >34 years in men
- Age >44 years in women
- Ages 2 to 20 years
- Family History of Total Cholesterol >300 mg/dl
- Family History Premature Coronary Artery Disease
- Age under 56 years in men
- Age under 66 years in women
- NIH as of 2011 recommends screening all ages 9-11 and again at 17-21years
- Screening protocol (repeated every 5 years)
- Full Fasting lipid profile preferred (ATP III guide)
- Alternative protocol: Non-Fasting lipid screening
- NCEP reasoning for non-Fasting lipid screening
- Non-Fasting screening improves compliance
- Postprandial Triglyceride rise can be evaluated
- Related to atherosclerosis risk
- Protocol
- Obtain non-Fasting Total Cholesterol with HDL
- Criteria to perform Fasting full lipid panel
- No Cardiac Risk Factors: Cholesterol >240 mg/dl
- Cardiac Risk Factors: Cholesterol >200 mg/dl
- HDL Cholesterol <40 mg/dl
- NCEP reasoning for non-Fasting lipid screening
- Alternative protocol: Non-Fasting Non-HDL Cholesterol
- Non-HDL Cholesterol = VLDL + IDL + LDL
- Correlates very well with outcomes
- Convenient (Patient does not need to fast)
- Goal Non-HDL Cholesterol is 30 higher than LDL goal
V. Evaluation: Framingham Risk Score (FRS)
- http://www.nhlbi.nih.gov/about/framingham/riskabs.htm
- NCEP Framingham Online Calculator
- Results of lowering LDL Cholesterol
- Relative CAD risk reduced 1% per 1% LDL decrease
VI. Management: Medication Management
VII. Management: Less than two Cardiac Risk Factors
-
Cholesterol Management
- Goal if LDL Cholesterol below 160 mg/dl (ideally <130)
- Low Fat Diet if LDL Cholesterol over 160 mg/dl
- Anti-hyperlipidemic if LDL Cholesterol over 190 mg/dl
- Monitoring
- Desirable lipids: Repeat Lipid panel in 5 years
- Borderline lipids: Repeat lipid panel in 1 year
- Elevated lipids: Repeat lipid panel in 3-6 months
VIII. Management: Two or more Cardiac Risk Factors
-
Cholesterol Management
- Goal LDL Cholesterol below 130 mg/dl
- Low Fat Diet if LDL Cholesterol over 130 mg/dl
- Anti-hyperlipidemic indications
- LDL Cholesterol over 130 (FRS 10 year risk <20%)
- LDL Cholesterol over 160 (FRS 10 year risk <10%)
- Monitoring
- Desirable lipids: Repeat Lipid panel in 1-2 years
- Borderline lipids: Repeat lipid panel in 6 months
- Elevated lipids: Repeat lipid panel in 2-3 months
IX. Management: Coronary Artery Disease or equivalent
-
Coronary Artery Disease equivalents
- Diabetes Mellitus
- Ten year Framingham Risk Score (FRS) 20% or higher
- Abdominal Aortic Aneurysm
- Peripheral Vascular Disease (e.g. Claudication)
- Symptomatic Carotid Artery disease
-
Cholesterol Management
- Goal LDL Cholesterol below 100 (ideally <70 mg/dl)
- Low Fat Diet if LDL Cholesterol above 100 mg/dl
- Anti-hyperlipidemic if LDL Cholesterol over 130 mg/dl
- Monitoring
- Desirable lipids: Repeat Lipid panel in 6-12 months
- Borderline lipids: Repeat lipid panel in 2-3 months
- Elevated lipids: Repeat lipid panel in 6 weeks
X. Management: CAD with multiple uncontrolled risks
- Goal LDL Cholesterol below 70 mg/dl
- Low Fat Diet if LDL Cholesterol above 70 mg/dl
- Anti-hyperlipidemic if LDL Cholesterol over 100 mg/dl
XI. References
- (2001) JAMA 285:2486-97 [PubMed]
- Ahmed (1998) Am Fam Physician 57(9):2192-203 [PubMed]
- Grundy (1997) Circulation 95:2329-31 [PubMed]
- Grundy (1997) Am Fam Physician 55(6): 2250-8 [PubMed]
- Mosca (2002) Am Fam Physician 65(2):217-26 [PubMed]
- Safeer (2002) Am Fam Physician 65(5):871-80 [PubMed]
- Yeshuran (1995) South Med J 88:379-91 [PubMed]
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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, コレステロールジョウショウ, 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 |
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 |