Dyslipidemia

Dr. Mahender Kumar

Asst Professor of Medicine
Lipids: water-insoluble organic molecules contribute to normal
metabolic process
Building blocks for cell membranes
Energy source
Fat-soluble vitamin absorption (needed)
Key molecule components (e.g. steroids, prostaglandins, bile acid)
Fat storage

Lipoproteins: triacylglycerol (TAG), cholesterol, phospholipids,

apolipoproteins
Classified according physicochemical characteristics
Lipid density, the apolipoproteins types contained (density → ↑ lipid
relative to protein)

Lipoprotein types: chylomicrons, very low-density lipoprotein

(VLDL), low- density lipoprotein (LDL), and high-density
lipoprotein (HDL)
Optimal lipid levels
Total cholesterol: 75-169mg/dL (ages ≤ 20 years); 100-199mg/dL (ages > 21 years)
LDL:

• < 70mg/dL (cardiovascular disease/ very high-risk individuals)

• < 100mg/dL (individuals with multiple cardiovascular disease risk-factors)
• < 130mg/dL (low cardiovascular disease risk individuals)
HDL: > 40mg/dL
Triglycerides: < 150mg/dL
Classification of Dyslipidaemia
 Primary – Familial dyslipidaemias
 Secondary – acquired

Fredrickson Classification
Common secondary causes of dyslipidemia
 Alcohol abuse
 Obesity
 Diabetes mellitus
 Hypothyroidism
 Autoimmune diseases
 Nephrotic syndrome
 Drugs – thiazides, glucocorticoids, anti-retroviral therapy, OCPs
RISK FACTORS
Western diet (e.g. ↑ refined carbohydrate, ↑ calorie, ↑ dietary fat levels)
Physical inactivity
Risk ↑ with age
Genetic/epigenetic influence

COMPLICATIONS
Atherosclerosis → cardiovascular, cerebrovascular disease
Pancreatitis

Cholelithiasis (some cases)

Retinopathy

Nephropathy

Fatty liver
SIGNS & SYMPTOMS
 Asymptomatic until atherosclerosis progresses, produces complications
 Abdominal adiposity (dyslipidemia correlation)
 Lipid-related skin eruptions (e.g. xanthomas, xantholasmas)
 Corneal arcus (Lipid deposition in peripheral cornea)
 Clinical presentation suggests lipid-related vascular disease
EVALUATION
 The primary evaluation tool for dyslipidemia is a fasting lipid panel which consists
of cholesterol, LDL, HDL, and triglycerides.
 There is some debate on at what age dyslipidemia screening should start
 Current recommendations are:
 Screen all males 35 years and older as well as high-risk males aged 20 – 35
 All females 45 years and older as well as high-risk females ages 20 – 45
 All individuals aged 20 – 78 years at least every five years if no atherosclerotic
disease is present.
 Atherosclerotic cardiovascular disease (ASCVD) risk score
 Treatment depends on underlying disease process.
Is it primary (familial) or secondary dyslipidemia?
Are the LDL levels higher than optimal?
What is the ASCVD risk?
Initial management for dyslipidemia involves lifestyle modifications.
This approach should include a diet with an emphasis on the intake of vegetables,
fruits, and whole grains within an appropriate calorie requirement.
Also, adults should participate in moderate to vigorous aerobic physical activity 3 to 4
times a week for at least 40 minutes.
Pharmacological therapy
 Statins – atorvastatin, rosuvastatin
 Ezetimibe
 PCSK9 inhibitors
 Bempedoic acid
 Bile acid sequestrants
 Thank you
for listening