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Semelhante a Hyperlipidmeia Advaces Management.pptx
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Hyperlipidmeia Advaces Management.pptx
- 2. CONTENTS • Introduction to lipoproteins and dyslipidemia • Non pharmacological management • Pharmacological management • Scenario
- 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
- 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