Dyslipidemia resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Classification

Causes

Secondary causes of dyslipidemia may cause either an increase in total-cholesterol & low density lipoprotein-cholesterol (LDL-C) or an increase in total triglycerides & very low density lipoprotein cholesterol (VLDL-C). Common causes are listed below.

Increase in Total Cholesterol and LDL-C

  • Hypothyroidism
  • Nephrosis
  • Dysgammaglobulinemia (systemic lupus erythematosus, multiple myeloma)
  • Cholestatic hepatic diseases due to abnormal lipoproteins (e.g. primary biliary cirrhosis)
  • Administration of protease inhibitors (treatment for HIV infection)
  • Administration of progestin or anabolic steroids

Increase in Total Triglycerides and VLDL-C

  • Chronic kidney disease
  • Type 2 diabetes mellitus
  • Obesity
  • Excessive alcohol intake
  • Hypothyroidism
  • Administration of anti-hypertensive therapy (thiazide diuretics or B-blockers)
  • Administration of corticosteroids
  • Severe stress that increases endogenous corticosteroid concentration
  • Elevated concentrations of estrogen (administration of oral (not transdermal) estrogen therapy, oral contraceptives, or pregnancy)
  • Administration of protease inhibitors (treatment for HIV infection)


To view a comprehensive list of dyslipidemia causes, click here

Screening

Abbreviations: ASA: American society of anesthesiologists; BP: Blood Pressure; CCS: Canadian cardiovascular society; CrCl: Creatinine clearance; CXR: Chest X-ray; DNI: Do not intubate; DNR: Do not resuscitate; ECG: Electrocardiogram; eGFR: estimated glomerular filtration rate; HR:Heart rate; INR: International normalized ratio; LMWH: Low molecular weight heparin; LV: Left ventricle; LVED: Left ventricular ejection fraction; NOAC: Novel oral anticoagulant; NPO: Nothing per os; PMI: Point of maximal impulse; PT: Prothrombin time; RR: Respiratory rate; SpO2: Oxygen saturation; T: Temperature; VT: Ventricular tachycardia

 
 
 
 
 
 
 
 
 
 
 
Identify risk factors for CAD

Major risk factors:

❑ Advanced age

❑ ↑ total serum cholesterol

❑ ↑ non-HDL-C (calculated by: total cholesterol minus HDL-C)

❑ ↑ LDL-C (either measured or calculated by: total cholesterol minus HDL-c minus (total triglycerides/5))

❑ ↓ HDL-C

❑ Diabetes mellitus

❑ Hypertension

❑ Cigarette smoking

❑ Family history of CAD

Additional risk factors:

❑ Obesity, especially abdominal

❑ Family history of hyperlipidemia

❑ Small, dense LDL-C

❑ ↑ Apo-B

❑ ↑ LDL particle number (measured by ApoB)

❑ Fasting/postprandial hypertriglyceridemia

❑ Polycystic ovarian syndrome

❑ Dyslipidemic triad

Non-traditional risk factors:

❑ ↑ lipoprotein

❑ ↑ clotting factors

❑ Inflamamtory markers (e.g. hsCRP or Lipoprotein-associated phospholipase A2 (Lp-PLA2)

❑ Hyperhomocysteinemia

❑ ApoE4 isoform

❑ ↑ uric acid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Determine the 10-year risk of coronary event using ANY of the following assessment tools:

❑ Framingham Risk Assessment Tool (To be redirected to Framingham Risk Assessment Tool, click here)

❑ Reynolds Risk Score (To be redirected to Reynolds Risk Score website, click here)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
High (Framingham 10-year global risk > 20%)
 
Intermediate (Framingham 10-year global risk between 10% and 20%)
 
 
 
Lower (Framingham 10-year global risk < 10%)
 
Optimal (Framingham 10-year global risk < 10% with optimal levels or risk factors and heart-healthy lifestyle)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient have type 2 diabetes mellitus?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient have ALL the following criteria for low-risk dyslipidemia?

❑ Low LDL-C < 100 mg/dL, AND

❑ HDL-C > 50 mg/dL, AND

❑ Triglycerides > 150 mg/dL
 
 
 
 
 
 
Adult patient
 
 
 
 
 
 
 
 
 
 
Pediatric patient (age > 2 years)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
Does that patient have risk factors for CAD (listed above)?
 
 
 
 
 
 
 
 
 
 
Does the patient have risk factors for CAD (listed above)?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ H01 }}}
 
{{{ H02 }}}
 
{{{ H03 }}}
 
 
 
{{{ H04 }}}
 
 
 
 
 
{{{ H05 }}}
 
{{{ H06 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ I01 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ J01 }}}
 
 
 
 
 
 
 
 
 
{{{ J02 }}}
 
 
 
 
 
{{{ J03 }}}
 
{{{ J04 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ K01 }}}
 
{{{ K02 }}}
 
{{{ K03 }}}
 
{{{ K04 }}}
 
{{{ K05 }}}
 
{{{ K06 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ L01 }}}
 
{{{ L02 }}}
 
{{{ L03 }}}
 
{{{ L04 }}}
 
{{{ L05 }}}
 
{{{ L06 }}}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Complete Diagnostic Approach

Treatment

Do's

Don'ts

References