Sandbox:Hyperlipoproteinemia type5

Jump to navigation Jump to search

Breast Cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Type chapter name here from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Radiation therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox:Hyperlipoproteinemia type5 On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:Hyperlipoproteinemia type5

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:Hyperlipoproteinemia type5

CDC on Sandbox:Hyperlipoproteinemia type5

Sandbox:Hyperlipoproteinemia type5 in the news

Blogs on Sandbox:Hyperlipoproteinemia type5

Directions to Hospitals Treating Type chapter name here

Risk calculators and risk factors for Sandbox:Hyperlipoproteinemia type5

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Person 1, Person 2, Your Name

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Any Disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

A reduced HDL-C level is associate with ASCVD

Diagnosis

Diagnosis of HLP type 5 is usually by clinical presentation.

  • History (including age of onset of symptomes in the patient and family members).
  • Physical findings such as eruptive xanthomas and tendon xanthomas.
  • Laboratory evaluation such as lipid levels and apolipoprotein assays.

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies The evaluation and treatment decisions of type 5 HLP should be based on patient-centered and individual circumstances. Lifestyle therapies, such as appropriate nutrition and physical activity, are important elements of ASCVD risk reduction, with or without lipid-altering drug therapy. For patients in whom lipid-altering drug therapy is indicated, statin treatment is the primary pharmacologic modality for reducing ASCVD risk.
Clinical algorithm for screening and management of elevated TG[1] description

Medical Therapy

When the triglyceride concentration is very high (≥500 mg/dL, and especially if ≥1000 mg/dL), the primary goal of therapy is to reduce the triglyceride level to <500 mg/dL for the intent of reducing the risk of pancreatitis.

Triglyceride concentration First line of therapy
≥1000mg/dl Triglyceride lowering agents such as
❑ Fibric acids
❑ High-dose [2 to 4 g/d] long-chain omega-3 fatty acids
❑ Nicotinic acid
500-999mg/dl ❑ Triglyceride lowering agents,
❑ Statins
200-499mg/dl Statin will generally be first-line drug therapy.If maximum tolerated statin therapy does not lower non-HDL-C below goal levels in patients with triglycerides 200 to 499 mg/dL, adding an agent that primarily lowers triglycerides may help to achieve atherogenic cholesterol goals.


When triglycerides are between 200 and 499mg/dL, the primary targets of lipid therapy are non–HDL-C and LDL-C for the purpose of reducing ASCVD risk.

Lipid treatment goals to reduce ASCVD risk[1]
Risk of ASCVD Indication for drug therapy Goal of drug therapy
Low ASCVD risk Non HDL- C* level ≥190mg/dl
LDL-C level ≥160mg/dl
Non HDL- C level <130mg/dl
LDL-C level <100mg/dl
Moderate ASCVD risk Non HDL- C* level ≥160mg/dl
LDL-C level ≥130mg/dl
Non HDL- C level <130mg/dl
LDL-C level <100mg/dl
High ASCVD risk Non HDL- C level ≥130mg/dl
LDL-C level ≥100mg/dl
Non HDL- C level <130mg/dl
LDL-C level <100mg/dl
Very high ASCVD risk Non HDL- C level ≥100mg/dl
LDL-C level ≥70mg/dl
Non HDL- C level <100mg/dl
LDL-C level <70mg/dl

Non–HDL-C comprises the cholesterol carried by all atherogenic particles, including LDL, intermediatedensity lipoproteins, very low-density lipoproteins (VLDL) and VLDL remnants, chylomicron remnants, and lipoprotein.[2]

Secondary Prevention

  • Lifestyle interventions are a key to efforts to reduce triglycerides that includes[1]
    • weight loss if overweight or obese
    • physical activity (≥ 150 minutes per week of moderate or higher intensity activity)
  • Restriction of alcohol
  • Restriction of sugar/refined carbohydrate intakes
  • For patients with very high TG level (≥500 mg/dL),chylomicronemia will generally be present. For such patients, a low-fat diet (,15% of energy) may be helpful to reduce entry of new chylomicron particles into the circulation.[1]
  • For patients with triglycerides <500 mg/dL, partial replacement of dietary carbohydrate (especially sugars and other refined carbohydrates) with a combination of unsaturated fats and proteins may help to reduce the triglyceride and non-HDL-C concentrations.

Case Studies

Case #1


References

Template:WH Template:WS

  1. 1.0 1.1 1.2 1.3 Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH et al. (2015) National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report. J Clin Lipidol 9 (2):129-69. DOI:10.1016/j.jacl.2015.02.003 PMID: 25911072
  2. Bays HE, Jones PH, Orringer CE, Brown WV, Jacobson TA (2016) National Lipid Association Annual Summary of Clinical Lipidology 2016. J Clin Lipidol 10 (1 Suppl):S1-43. DOI:10.1016/j.jacl.2015.08.002 PMID: 26891998