lipid disorder (dyslipidemia)

Introduction

see hyperlipidemia or more specific type

Pathology

• adverse consequences of dyslipidemia begin early in life

Laboratory

• screening with lipid panel
  • adults 40-75 years of age (USPSTF)
    • annually for high-risk patients
    • every 4 years for patients with borderline LDL cholesterol
    • every 5 years for patients at low risk with normal lipid profiles
    • longer intervals may be considered for consistently normal results
• no specific LDL cholesterol or non-HDL cholesterol targets recommended
• nonfasting lipid panel no more than every 10 years [[16]
• additional testing to refine risk prediction is not recommended,
  • serum CRP marginally improves risk predictive, thus not recommended
• fasting lipid measurement is not required
  • nonfasting total cholesterol & HDL cholesterol levels differ little from fasting measurements
  • fasting LDL cholesterol levels might be 10% lower than a
  • fasting serum triglyceride levels might be 20% lower than a fasting level
• baseline testing should be obtained before initiating statin therapy
  • serum creatine kinase levels
    • not indicated in the absence of myalgias
  • liver function tests
• routine monitoring of serum lipids, serum creatine kinase, or liver function tests during follow-up is not recommended

Radiology

• coronary artery calcium
  • may improve risk prediction, but effect is considered small
  • no evidence that testing improves outcomes, thus not recommended

Management

• dietary intervention is always indicated
  • limit total fat to 25-35% of calories
  • limit saturated fat to < 7% of calories
• Mediterranean diet recommended for primarg & secondary prevention
• aerobic exercise of any intensity & duration is recommended
• statins
  • no benefit of statin if 10 year cardiovascular (CV) risk is < 6%
  • limited evidence of benefit (~8% CV risk reduction) when 10 year CV risk reduction is 6-12%
    • net benefit of statins in this group is uncertain
    • decision to initiate therapy should be shared with the patient
  • with 10 year CV risk is >12%, statins lower CV risk by 20-30%
  • treat to target statin dose not to LDL cholesterol
  • moderate-dose statin therapy for secondary prevention
    • additive benefit of high-dose statin therapy is relatively small
    • ~ 6 fewer adverse CV events per 1000 patients treated with high-dose vs moderate-dose statin for 5 years
  • AHA/ACC recommendations for statin therapy
    • LDL cholesterol > 190 mg/dL
      • LDL-cholesterol > 70 mg/dL AND
        • diabetes mellitus OR
        • 10 year cardiovascular risk >= 7.5%
• PCSK9 inhibitors
  • not recommended for primary prevention
  • recommended if risk factors, on maximum statin & ezetimibe therapy & LDL-cholesterol > 130 mg/dL
• no benefit in lowering LDL cholesterol below 70 mg/dL

More general terms

• syndrome
• metabolic disease

More specific terms

• hyperlipidemia
• hyperlipoproteinemia (HLP)
• hypolipoproteinemia
• lipid metabolism, inborn error; lipid storage disease; lipidosis
• lipodystrophy; lipoatrophy
• lipomatosis
• steatosis; fatty liver; nonalcoholic fatty liver disease (NAFLD); metabolic dysfunction-associated steatotic liver disease (MASLD)

Additional terms

• lipid panel (fasting lipid panel, FLP)