Hyperlipidmeia Advaces Management

1. Management
of
Dyslipidemia

2. CONTENTS
• Introduction to lipoproteins and dyslipidemia
• Non pharmacological management
• Pharmacological management
• Scenario

3. Lipoproteins
• Atherogenic
• Non
atherogenic
• Lp(a) ?

4. Composition

5. Lipidprofiling
• Lipoprotein measurement – ApoB
• Lipid profile
• Fasting or not ?
Total Cholesterol 120-200
Triglycerides 10-150
HDL Cholesterol 40-60
LDL Cholesterol <130
VLDL Cholesterol Upto 30

6. DYSLIPIDEMIA
• Dyslipidemias are
generally characterized
clinically by increased
plasma levels of
cholesterol, TGs, or
both, variably
accompanied by
reduced levels of HDL
cholesterol
Dyslipidemia
Familial/Genetic
Secondary

8. •High dose statin therapy is initiated or
continued as early as possible
•Goal 50% reduction of LDL-C, to <55 mg/dL
•Initial Ezetimibe then PCSK9 inhibitors
•Loading with high dose statins before PCI.
•Intensive statin therapy after TIA & Stroke

9. PRIMARY
PREVENTION

10. Risk
calculators

12. Raised LDL

13. DIABETES
• IA--- > 40 to 75 years age with diabetes– moderate intensity
Statins
• II A---- assess ascvd risk and If multiple RFs – higher intensity
Statins to reduce ldl by 50 %
• II A ---- > 75 years-old, if on statins- continue
• II B --- Adults with diabetes with ascvd risk >20% -add
ezetimibe.
• II B----- >75 years old with DM, not on statins – start based
on risk- benefit ratio

14. Old age
•For given TC higher risk in elderly.
•Multiple co-morbities, Medications
•Different pharmacokinetics and dynamics
•Statins to be started at low doses and
titrate.

15. Children
• Family history of early CVD & hypercholesterolemia –
screening from 2 years
• With obesity and Metabolic syndrome- testing
• Lifestyle changes and caloric restrictions.
• >190 or >160 mg/dL with FH after failure of above
• Reverse cascade of screening.

16. WOMEN
•Statins are preferred.
•OCPs ? >160mg/dL
•Oestrogen Replacing therapy ?
•Pregnancy and lactation: BAS and lipid apheresis

17. CKD
• Increased risk of both
atherosclerotic vascular
disease and structural
heart disease
• Specifically rise of TG,
Lp(a)

18. CKD contd

19. Inflammatory conditions
• Rheumatoid arthritis (RA), glomerulosclerosis, or pulmonary
fibrosis
• CVD has been cited as the top cause of death in people with RA
• HIV - Immune dysregulation, Systemic inflammation, Antiretroviral
therapy & Dyslipidemia
• Role of hs-CRP, CAC, intimal thickness.
• Assess Risk score and start based on score
• Start on low doses and check for drug interactions.

20. Raised TG
• TGs are associated but not causal for ASCVD
• Drugs used are statins, fibrates, niacin, ω-3 Fatty Acids
• Treatment to be started If > 200 mg/dL
• Lifestyle and dietary modifications
• 885-1000:Lipid apheresis and insulin infusion till 500

22. Dyslipidemia as a cause ofPancreatitis

23. Lipoprotein (a)
• Screen if Premature ASCVD, Familial
• Limited evidence in reducing ascvd on lowering levels
• Drugs – PCSK9 inhibitors, Niacin
• Statins increase

24. Thankyou