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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify the major components within each lipoprotein and their role in lipoprotein metabolism and the development of atherosclerosis.

  2. Identify the common types of lipid disorders.

  3. Determine a patient's coronary heart disease risk and corresponding treatment goals according to the National Cholesterol Education Program Adult Treatment Panel III guidelines.

  4. Recommend appropriate therapeutic lifestyle changes (TLC) and pharmacotherapy interventions for patients with dyslipidemia.

  5. Identify the diagnostic criteria and treatment strategies for metabolic syndrome.

  6. Describe the components of a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for dyslipidemias.

  7. Educate patients about the disease state, appropriate TLC, and drug therapy required for effective treatment.

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KEY CONCEPTS

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  • Image not available. The risk of atherosclerosis is directly related to increasing levels of serum cholesterol.

  • Image not available. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III guidelines have set the "optimal" level for low-density lipoprotein (LDL) cholesterol for all adults as less than 100 mg/dL (2.59 mmol/L).

  • Image not available. The NCEP guidelines recommend that all adults older than 20 years should be screened at least every 5 years using a fasting blood sample to obtain a lipid profile.

  • Image not available. The benefits of lowering LDL cholesterol to as low as 70 mg/dL (1.81 mmol/L) have been demonstrated in clinical trials; however, the lowest level at which to treat LDL cholesterol where there are no further benefits in coronary heart disease (CHD) risk has not yet been determined.

  • Image not available. An adequate trial of therapeutic lifestyle changes (TLC) should be used in all patients, but pharmacotherapy should be instituted concurrently in higher-risk patients.

  • Image not available. Typically, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (or statins) are the medications of choice to treat high LDL cholesterol because of their: (1) ability to substantially reduce LDL cholesterol and reduce morbidity and mortality from atherosclerotic disease; (b) convenient once-daily dosing; and (c) low risk of side effects.

  • Image not available. Patients with metabolic syndrome have an additional lipid parameter that needs to be assessed, namely non–high-density lipoprotein (non-HDL) cholesterol (total cholesterol minus HDL cholesterol). The target for non-HDL cholesterol is less than the patient's LDL cholesterol target plus 30 mg/dL (0.78 mmol/L).

  • Image not available. After assessment and control of LDL cholesterol, patients with serum triglycerides of 200 to 499 mg/dL (2.26 to 5.64 mmol/L) should be assessed for atherogenic dyslipidemia (low HDL cholesterol and increased small-dense LDL particles) and metabolic syndrome.

  • Image not available. Combination drug therapy is an effective means to achieve greater reductions in LDL cholesterol (statin plus ezetimibe or bile acid resin, bile acid resin plus ezetimibe, or three-drug combinations) as well as raising HDL cholesterol and lowering serum triglycerides (statin plus niacin or fibrate).

  • Image not available. The evidence of reducing LDL cholesterol while substantially raising HDL cholesterol (statin plus niacin or fibrate) to reduce the risk of CHD-related events to a greater degree than statin monotherapy remains in question.

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INTRODUCTION

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Image not available. The risk of atherosclerosis is directly related to increasing levels of ...

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