6/6/2017 0 Comments Dyslipidemia Diet TreatmentHigh cholesterol Overview - Mayo Clinic. Cholesterol is a waxy substance that's found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol can increase your risk of heart disease. When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen- rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke. High cholesterol can be inherited, but it's often the result of unhealthy lifestyle choices, and thus preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol. American Association of Clinical Endocrinologists' guidelines for management of dyslipidemia and prevention of atherosclerosis. The levels of evidence (EL) (1 to 4) and the recommendation grades (A to D) are defined at the end of the . Dyslipidemia Treatment AlgorithmThe best evidence level (BEL), which corresponds to the best conclusive evidence found, accompanies the recommendation grade in this summary. Reference citations include the EL numerical descriptor. Q1. How Should Individuals Be Screened for the Detection of Dyslipidemia? Q1. 1. Global Risk Assessment. Dyslipidemia treatment: Get the facts. Lifescript offers answers to your common health and medical questions. The No-Diet Approach. Medical Definition of Dyslipidemia. MedicineNet does not provide medical advice, diagnosis or treatment. Dyslipidemia means an abnormal amount of lipids, or fats. Increased activity and a healthy diet should be the first course of treatment for dyslipidemia. The rationale for the treatment of diabetic dyslipidemia is discussed in detail in the American Diabetes Association (ADA) technical review “Management of. Dyslipidemia information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT October 2015 CCHCS Care Guide: Dyslipidemia 3 SECONDARY CAUSES OF DYSLIPIDEMA 1. Berglund, L, Brunzell, JD. R1. Identify risk factors (see Table 5 in the original guideline document) (National Institutes of Health, 2. Additional risk factors (obesity, family history, elevated apo B, increased low- density lipoprotein (LDL) particle number, small dense LDL, fasting/postprandial hypertriglyceridemia, polycystic ovary syndrome in women, dyslipidemic triad) should be considered, as should nontraditional risk factors (e. C- reactive protein . Determine the 1. 0- year risk (high, intermediate, low) of a coronary event using the Framingham Risk Assessment Tool or Reynolds Risk Score (www. CRP and family history of premature CAD) (Grade A; BEL 4). R3. Because of the diagnostic difficulties and differences in clinical presentation, the American Association of Clinical Endocrinologists (AACE) recommends that special attention be given to assessing women for CAD risk. Determine the 1. 0- year risk (high, intermediate, low) of a coronary event using Reynolds Risk Score (www. Framingham Risk Assessment Tool (Grade A; BEL 4). The Framingham Risk Score provides 1. When a person has dyslipidemia there are no symptoms but it can cause other. Most physicians will use the common treatment of exercise and eating a diet that. The first approach to treatment of dyslipidemia is lifestyle modification. The mainstay of treatment is diet modification. A low-saturated-fat. Dyslipidemia Treatment. The treatment of dyslipidemia depends on the age, symptoms and overall health of the patient. The probability of the dyslipidemia to progress. Hormone Health Network wants to keep your heart healthy. Learn about dyslipidemia symptoms and treatment today. Table 7 in the original guideline document) (Lloyd- Jones et al., 2. AACE recommends early diagnosis and management of pediatric dyslipidemia to reduce the levels of LDL- C that may eventually increase risk of cardiovascular events in adulthood (Grade A; BEL 1). Classification of LDL- C levels as acceptable, borderline, or high is outlined in Table 8 in the original guideline document (American Academy of Pediatrics, 1. Categorize lipid- related risks as optimal/near- optimal, borderline, and high risk (see Table 9 in the original guideline document) (National Institutes of Health, 2. An HDL- C concentration greater than 6. L is an independent negative risk factor in both sexes, and when the HDL- C concentration is greater than 6. L, one risk factor can be subtracted from a patient's overall risk profile (Grade A; BEL 1). R6. AACE recommends classifying elevated triglycerides (see Table 1. National Institutes of Health, 2. Screening. R7. AACE recommends more frequent assessments for all patients with a family history of premature CAD (definite myocardial infarction . AACE suggest considering more frequent testing for individuals with CAD risk factors (Grade C; BEL 4). Adults with Diabetes. R8. Annually screen all adult patients with diabetes mellitus for dyslipidemia (Grade B; BEL 2). Young Adults (Men Aged 2. Years, Women Aged 2. Years)R9. Evaluate all adults 2. Grade A; BEL 3). Middle- Aged Adults (Men Aged 4. Years, Women Aged 5. Years)R1. 0. In the absence of CAD risk factors, screen middle- aged persons for dyslipidemia at least every 1 to 2 years. AACE recommends more frequent lipid testing when multiple global CAD risk factors are present (Grade C; BEL 3). The frequency of testing should be based on individual clinical circumstances and the clinician's best judgment (Grade C; BEL 4). Older Adults (Older Than 6. Years)R1. 1. Annually screen older adults with 0 to 1 CAD risk factor for dyslipidemia (Grade C; BEL 1). In addition, older patients should undergo lipid assessment if they have multiple CAD global risk factors (i. Grade C; BEL 4). R1. AACE believes that screening recommendations apply based on age and risk, not based on sex; therefore, women should be screened in the same way as men (Grade A; BEL 1). Children and Adolescents. R1. 3. Screen children older than 2 years every 3 to 5 years if they have CAD risk factors or a family history of premature CAD or dyslipidemia, are overweight or obese, have other elements of the insulin resistance syndrome, or have no available family history (Grade A; BEL 4). R1. 4. Screen adolescents older than 1. CAD risk factors, are overweight or obese, have other elements of the insulin resistance syndrome, or have a family history of premature CAD (Grade A; BEL 3). AACE joins the American Heart Association and the US Preventive Services Task Force in recommending further research to determine the effect of pediatric dyslipidemia screening and treatment on adult outcomes (Mc. Crindle et al., 2. Which Screening Tests Are Recommended for the Detection of Cardiovascular Risk? Q2. 1. Fasting Lipid Profile. R1. 5. Use a fasting lipid profile to ensure the most precise lipid assessment. This should include total cholesterol, LDL- C, triglycerides, and high density lipoprotein- C (HDL- C) (Grade C; BEL 4). Q2. 2. Low- Density Lipoprotein Cholesterol. Calculated. R1. 6. AACE does not recommend estimating LDL- C values in certain clinical circumstances. LDL- C is frequently and inexpensively estimated using the Friedewald equation: (Grade A, BEL 1) (National Institutes of Health, 2. It becomes increasingly inaccurate when triglyceride levels are greater than 2. L, and the equation is no longer valid when triglyceride levels are greater than 4. L. Direct Measurement. R1. 7. AACE recommends direct measurement of LDL- C in certain high- risk patients, such as those with fasting triglyceride levels greater than 2. L or those with diabetes mellitus or known vascular disease (Grade C; BEL 3). Q2. 3. HDL- Cholesterol. R1. 8. AACE recommends measurement of HDL- C as a screening test for dyslipidemia. Low HDL- C can act synergistically with other lipid risk factors to increase CAD risk. An HDL- C concentration greater than 6. L is an independent negative risk factor in both sexes. Q2. 4. Non–HDL- CR1. Calculate non–HDL- C (total cholesterol minus HDL- C) in patients with moderately elevated triglycerides (2. L), diabetes mellitus, and/or established CAD (Grade C; BEL 2). R2. 0. If insulin resistance is suspected, AACE recommends evaluating non–HDL- C to gain useful information regarding the patient's total atherogenic lipoprotein burden. In addition, in any circumstance when triglycerides are 2. L or greater but less than 5. L, a non–HDL- C calculation will provide better risk assessment than LDL- C alone (Grade C; BEL 4). Non–HDL- C targets are 3. L higher than established LDL- C risk levels (Grade C; BEL 4). Q2. 5. Triglycerides. R2. 1. Increasing clinical evidence suggests that elevated triglycerides may be an independent risk factor for CAD; therefore, AACE recommends screening of triglycerides as a component of lipid screening. Triglycerides levels that are even moderately elevated (> 1. L) may identify individuals at risk for the insulin resistance syndrome. Triglyceride levels 2. L or greater may indicate a substantial increase in CAD risk (National Institutes of Health, 2. Apolipoproteins. R2. AACE recommends that optimal apo B levels for patients at risk of CAD, including those with diabetes, are less than 9. L, while patients with established CAD or diabetes who have one or more additional risk factor(s) should have an apo B goal of less than 8. L (Grade D; BEL 4). When the triglyceride level is greater than 1. L or the HDL- C level is less than 4. L, AACE believes that the apo B or the apo B to apo AI ratio may be particularly useful in assessing residual risk in patients at risk for CAD (even when LDL- C levels are controlled); this includes patients with established CAD, type 2 diabetes, or the insulin resistance syndrome who are at high risk for CAD. AACE therefore recommends apo B testing in such patients (Grade B; BEL 2). R2. 3. AACE recommends apo B measurements to assess the success of LDL- C–lowering therapy. Apo B reflects LDL particle number, which may be elevated in patients at or below LDL- C goal. While LDL- C and LDL particle size (e. LDL) are associated with atherogenicity, LDL particle number as reflected by apo B is a more potent measure of cardiovascular disease (CVD) risk than either of these two measures (Grade B; BEL 2). R2. 4. AACE believes that assessment of apo AI may be useful in certain cases (Grade B; BEL 2). A normal apo AI level in a patient with low HDL- C suggests the existence of an adequate number of HDL- C particles that contain less cholesterol and may be an indication of less risk. The INTERHEART study found that the apo B to apo AI ratio was among the most significant risk factors for MI (Yusuf et al., 2. Secondary Causes of Dyslipidemia. R2. 5. Rule out secondary causes of dyslipidemia. Numerous conditions may variably affect total cholesterol and LDL- C or triglycerides and very low- density lipoprotein cholesterol (VLDL- C) (see Table 1. National Institutes of Health, 2. Additional Tests. R2. 6. Assess markers of inflammation in patients where further stratification of risk is necessary. Highly sensitive CRP and Lp- PLA2 provide useful additional information in these instances and appear to be synergistic in predicting risk of CVD and stroke (Grade B; BEL 1). R2. 7. Use highly sensitive CRP to stratify CVD risk in patients with a standard risk assessment that is borderline, or in those with an LDL- C concentration less than 1. L (Grade 2; BEL B). R2. 8. Measure Lp- PLA2, which in some studies has demonstrated more specificity than highly sensitive CRP, when it is necessary to further stratify a patient's CVD risk, especially in the presence of systemic highly sensitive CRP elevations (Grade 2; BEL B). R2. 9. AACE does not recommend routine measurement of homocysteine, uric acid, plasminogen activator inhibitor 1, or other inflammatory markers because the benefit of doing so is unclear (Grade 4; BEL D). Although recent data from the third National Health and Nutrition Examination Survey (Park et al., 2. Department of Health and Human Services, 2.
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