Male patient aged 35 Male patient aged 35 ysys

C/o of skin lesions over the C/o of skin lesions over the extensor surface of both extensor surface of both

elbows and kneeselbows and knees

Bp 130/80, pulse 80 regularBp 130/80, pulse 80 regular

NeckNeck ChestChest HeartHeart AbdAbd N SN S

Lab ValuesLab Values

Total cholesterol 508 mg%Total cholesterol 508 mg% Trigliceride 2894Trigliceride 2894 Random Sugar 338Random Sugar 338 ECG T wave changes in LIII, aVF,V3-ECG T wave changes in LIII, aVF,V3-

V6V6

Ask patient 3 questionsAsk patient 3 questions

Family history DM,Family history DM, DyslipedimiaDyslipedimia Early IHD in familyEarly IHD in family Thyroid diseaseThyroid disease Drug intakeDrug intake Liver,kidney diseases Liver,kidney diseases

Inferiolateral ischemiaInferiolateral ischemia

Investigations recomendedInvestigations recomended

Lipid profileLipid profile Liver functionLiver function Renal functionRenal function Thyroid functionThyroid function Cardiology consultation Why?Cardiology consultation Why?

Causes of secondary Causes of secondary hyperlipidemiahyperlipidemia

Cholestatic liver diseasesCholestatic liver diseases Nephrotic syndromeNephrotic syndrome Chronic renal failureChronic renal failure HypothyroidismHypothyroidism Cigarette smokingCigarette smoking ObesityObesity DrugsDrugs

Expected complicationsExpected complications

IHD, accelerated atherosclerosisIHD, accelerated atherosclerosis PancreatitisPancreatitis Gall bladder diseaseGall bladder disease Related to medicationsRelated to medications Complications of Diabetes Complications of Diabetes

LipoproteinLipoprotein

Type of lipoproteinsType of lipoproteins

Lipoproteins suclassesLipoproteins suclasses

DyslipedimiaDyslipedimia

Lipid Fredrekhsen Lipid Fredrekhsen classificationclassification

Plan of your treatmentPlan of your treatment

DietDiet Diabetes controlDiabetes control IHD, accelerated atherosclerosisIHD, accelerated atherosclerosis Hypolipemic Hypolipemic

medications,Statin,Fibrate,Resin medications,Statin,Fibrate,Resin uptake,ezetimibe, nicotinic acid,lipid uptake,ezetimibe, nicotinic acid,lipid apheresisapheresis

othersothers

Mechanism of action StatinsMechanism of action Statins

Are specific competitive inhibitors of Are specific competitive inhibitors of microsomal enzyme HMG-CoA microsomal enzyme HMG-CoA reductase, which catalyses the reductase, which catalyses the conversion HMG-Co Aconversion HMG-Co A

To mevalonate, a rate- determining To mevalonate, a rate- determining step in cholesterol synthesis step in cholesterol synthesis

Mechanism of action of Mechanism of action of FibratesFibrates

ADR of StatinsADR of Statins

Statins , Rhabdomyalgia , Statins , Rhabdomyalgia , RhabdomyolysisRhabdomyolysis

Renal impairementRenal impairement Raise transaminasesRaise transaminases GITGIT

APHERESISAPHERESIS