This is a brief video on hypercholesterolemia, covering pathophysiology, presentation, screening, diagnosis, statins, and other drugs.

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By Manu5 - [ Ссылка ], CC BY-SA 4.0, [ Ссылка ] dyslipidemia hyperlipidemia hypercholesterolemia Hypercholesterolemia Overview & pathophysiology Cause & presentation Definition & diagnosis Treatment & drugs Overview / pathophys Cholesterol is transported in the blood Simplified model; categorized according to the density of particles: HDL: “Good” cholesterol → clears cholesterol plaques from peripheral blood vessels, returns to liver (protective effect) LDL, others: “Bad” cholesterol → distributes cholesterol to periphery, where can block arterial lumen → MI, CVA, CS, PVD, RAS, etc By Npatchett - Own work, CC BY-SA 3.0, [ Ссылка ] Overview & pathophys Cause & presentation Definition & diagnosis Treatment & drugs Non-modifiable risk factors: age, M F Environmental risk factors: weight, diet, stress, inactive lifestyle Associated conditions (and how to find them): type 2 diabetes (glucose/A1c), obesity (BMI), alcohol (CAGE), hypothyroidism (TSH), Cushing's syndrome (cortisol), liver dz (LFTs), renal dz (Cr, BUN, urine protein), pregnancy Meds: estrogen, glucocorticoids, thiazide diuretics Primary: familial dyslipidemia syndromes (types I-V) Who to screen: annual lipid panel in all M 35, W 45, or any patients 20 yo with CV disease (aorta, peripheral, coronary, carotid) Typically diagnosed from screens Genetic dyslipidemia syndromes sometimes present with examination findings → Xanthoma (tuberosum): yellow solid mass on tendons By Min.neel - Own work, CC BY-SA 3.0, [ Ссылка ] Xanthelasma: yellow plaque on eyelids By Bobtheowl2 at the English Wikipedia, CC BY-SA 3.0, https:// com mons .wikimedia.org/ w/ind ex.php?curid=4040642 Overview & pathophys Cause & presentation Definition & diagnosis Treatment & drugs Who gets a statin? Pt with atherosclerotic cardiovascular dz (ASCVD) Pt with LDL = 190 Pt with LDL 70 and ASCVD risk score of =7.5% (10%) LDL 70 who is old and/or diabetic and/or hypertension and/or smoker Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–S45. Definition / diagnosis LDL 70 can reduce atherosclerosis National Heart Lung and Blood Institute; National Institutes of Health: High Blood Cholesterol: What You Need To Know Interpretation of cholesterol levels type range (mg/dL) interpretation total cholesterol 200 desirable 200–239 borderline 240 high LDL cholesterol 100 most desirable 100–129 good 130–159 borderline high 160–189 high and undesirable 190 very high HDL cholesterol 40 undesirable; ↑risk 41–59 okay, but not optimal 60 good; risk lowered Overview & pathophys Cause & presentation Definition & diagnosis Treatment & drugs Statins: High-intensity: decrease LDL 50% atorvastatin 40, 80 mg rosuvastatin 20, 40 mg Moderate-intensity: decrease LDL 30-50% atorvastatin 10, 20 mg rosuvastatin 5, 10 mg lovastatin 40 mg pravastatin 40, 80 mg simvastatin 20, 40 mg Low-intensity: decrease LDL 30% lovastatin 20 mg pravastatin 10, 20 mg simvastatin 5, 10 mg Before starting, take baseline: lipids, LFTs, CK, A1c Monitor: lipids annually; DM every 3 months; LFTs/hepatitis upon starting, with symptoms (RUQ, jaundice); CK with muscle symptoms (sore, weak muscles) If myositis, hepatitis → try a lower dose Treatment / drugs Can’t take a statin? Try… Fibrates (fenofibrate, gemfibrozil): (second line to statins) MoA: ↑lipoprotein lipase → ↓TG, ↑HDL SE: myositis (don’t combine with statins) Ezetimibe MoA: ↓cholesterol absorption → ↓LDL SE: diarrhea Bile acid sequestrant (cholestyramine, colestipol, colesevelam): MoA: resin that binds lipids, sequesters them from enterohepatic circulation → body then produces and dumps more bile acid → ↓LDL SE: diarrhea Niacin MoA: ↓free fatty acids released from body fat → liver can’t make lipoproteins → ↓LDL synthesis SE: pruritus, ↑blood glucose, ↑uric acid, flushing (give aspirin) Overview & pathophys Cause & presentation Definition & diagnosis Treatment & drugs

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