HyperlipidemiaHyperlipidemia

AcronymsAcronyms

HDLHDL High density lipoproteinsHigh density lipoproteins

LDLLDL Low density lipoproteinsLow density lipoproteins

VLDLVLDL Very low density lipoproteinsVery low density lipoproteins

HMG-CoAHMG-CoA 3-hydroxy 3 methylgultaryl-coenzyme A3-hydroxy 3 methylgultaryl-coenzyme A

Cholesterol: Bad, Good & UglyCholesterol: Bad, Good & Ugly

DesirableDesirable Total Cholesterol < 200mg/dLTotal Cholesterol < 200mg/dL LDL cholesterol < 130 mg/dLLDL cholesterol < 130 mg/dL

LDL (the bad) +LDL (the bad) + HDL (the good) +HDL (the good) + VLDL (the neither) = total cholesterolVLDL (the neither) = total cholesterol

Risk FactorsRisk Factors

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Risk FactorsRisk Factors

Cigarette smoking, inactivityCigarette smoking, inactivity Family History of CHDFamily History of CHD Hypertension, Diabetes, ObesityHypertension, Diabetes, Obesity Age and GenderAge and Gender

Men >45yoMen >45yo Women >55yoWomen >55yo

Low HDL <40mg/DLLow HDL <40mg/DL

PathophysiologyPathophysiology

DefinitionsDefinitions OverviewOverview Risk factorsRisk factors

Non drug therapyNon drug therapy

TRAVELS with HDLTRAVELS with HDL

Therapeutic AgentsTherapeutic Agents

NIACINNIACIN MOAMOA SESE DoseDose Patient EducationPatient Education Why not Niacinamide?Why not Niacinamide?

Fibric AcidFibric Acid MOAMOA SESE DoseDose Patient EducationPatient Education Gemfibrozil (Lopid)Gemfibrozil (Lopid) Fenofibrate (Tricor)Fenofibrate (Tricor)

Bile Acid Resins “Statins”Bile Acid Resins “Statins”

MOAMOA DoseDose ToxicityToxicity AgentsAgents

Colestipol (Colestid)Colestipol (Colestid) Cholestyramine Cholestyramine

(Questran)(Questran)

Competitive inhibitors Competitive inhibitors of HMG-CoA of HMG-CoA ReductaseReductase

ToxicityToxicity AgentsAgents

Atorvastatin (Lipitor)Atorvastatin (Lipitor) Fluvastatin (Lescol)Fluvastatin (Lescol) Lovastatin (Mevacor)Lovastatin (Mevacor) Pravastatin (Pravachol)Pravastatin (Pravachol) Simvastatin (Zocor)Simvastatin (Zocor)

Major Side EffectsMajor Side Effects

NiacinNiacin GI complaints, flush, gout, GI complaints, flush, gout, increase glucoseincrease glucose

Fibric AcidFibric Acid GI complaints, increase risk of GI complaints, increase risk of gallstonesgallstones

Bile Acid Bile Acid

SequestrantsSequestrants

GI complaints, decrease GI complaints, decrease absorption of other drugsabsorption of other drugs

StatinsStatins Myalgia, Myalgia, ↑↑ liver enzymes, liver enzymes, rhabdomyolysis*rhabdomyolysis*

“STATINS”Lovastatin (Mevacor)Atorvastatin (Lipitor)

•Ezetimibe

(Zetia)

Additional TherapiesAdditional Therapies

Intestinal absorption inhibitorIntestinal absorption inhibitor ZETIA (ezetimide)ZETIA (ezetimide)

CombinationCombination VytorinVytorin

FiberFiber Dietary Dietary

Intake Intake Psyllium Psyllium

(Metamucil,(Metamucil,

Fiberall)Fiberall)

The TRAPEZOID !The TRAPEZOID !

Overall Dietary ManagementOverall Dietary Management

Optimize WeightOptimize Weight Restrict fat intakeRestrict fat intake Restrict alcohol intakeRestrict alcohol intake Limit intake of sweetsLimit intake of sweets Increase fiber intakeIncrease fiber intake Increase fish consumptionIncrease fish consumption

Summary SlideSummary Slide

AcronymsAcronyms Cholesterol: Bad, Good & UglyCholesterol: Bad, Good & Ugly Risk FactorsRisk Factors Therapeutic AgentsTherapeutic Agents Major Side EffectsMajor Side Effects Additional TherapiesAdditional Therapies Overall Dietary ManagementOverall Dietary Management

Lipids CASE STUDYLipids CASE STUDY

BB is a white male, 15kg over ideal body weight. He presents a BB is a white male, 15kg over ideal body weight. He presents a prescription for Lipitor 20mg qd #30 with 6 refills. His HMO prescription for Lipitor 20mg qd #30 with 6 refills. His HMO does not prefer the choice. He is irritated that the doctor has to does not prefer the choice. He is irritated that the doctor has to be called. He must come back. He attempts to berate the be called. He must come back. He attempts to berate the ancillary and is cut off during his tirade by the pharmacist. ancillary and is cut off during his tirade by the pharmacist. She offers to have him use the pharmacy phone to call his She offers to have him use the pharmacy phone to call his doctor’s office himself. He responds, “No, that is your job” doctor’s office himself. He responds, “No, that is your job” and leaves. The orders are changed to Pravachol 20mg qd. On and leaves. The orders are changed to Pravachol 20mg qd. On consultation the patient remarks, “Just give me the cream consultation the patient remarks, “Just give me the cream cheese and pasta pills and let me go!”cheese and pasta pills and let me go!”

Three months later the physician adds Questran Lite 1 pak po Three months later the physician adds Questran Lite 1 pak po mixed with juice TID #60 with 6 refills. Upon consultation the mixed with juice TID #60 with 6 refills. Upon consultation the patient is no longer glib. He is genuinely concerned and patient is no longer glib. He is genuinely concerned and scared that his cholesterol number is 310. He wants scared that his cholesterol number is 310. He wants information from you.information from you.

Points to PonderPoints to Ponder

Where should BB’s cholesterol number be? Where should BB’s cholesterol number be? Why? Why?

Define LDL, HDL, VLDL.Define LDL, HDL, VLDL. List some dietary options in BB’s managementList some dietary options in BB’s management What are the risks of non-treatment?What are the risks of non-treatment? Provide BB with patient education regarding Provide BB with patient education regarding

Questran and Pravachol.Questran and Pravachol.