48

. . . .
15-18 / 5 / 2013

.

.

 :
>5

, CT scan,

: 7 - 23 100.000 ( 70%,
20%, 10%.

6-9%

-
- ( )

- ( ) ( )

 :

-
-
-

-
- ,
-

- : Grey Turner Cullen

 :


,

TRG<150mg/dl: OPTIMAL TRIGLYCERIDE LEVELS

TRG 150-500mg/dl:
TRG>500mg/dl:

TRG>1000mg/dl

 Y
LPL ( )
APOCII APOAV


(ITP/ GRAVES/ Sjgren)
LPL

Y

(TRG>1.000mg/dl)

J Clin Endocrinol Metab 2011;96:3302-7


48 ,
98kg, TRG 1.400mg/dl.
5
(50mg/) (5mg/). T
CHOL 710mg/dl, HDL CHOL 22mg/dl, 140mg/dl.

(eruptive xanthomas)

(2-3 )

J Clin Aesthet Dermatol 2011;4:44-6


TRG

 TRG
-


(1)

:
:
:

( 200mg/)

(5-10%)

20%

10-15%

(-3 )

5-10%

1-2% ( 1%

TRANS

1%( 1%


TRG
+++ ( TRG 20-30%)
+++ (<1-2 /10-30g/d)
+++
++
++
-3 ++
- +


(2)
3:

4.5kg

122mg/dl, H1c 6.8% ( )

TRG : 390mg/dl

HDL CHOL: 34mg/dl

T CHOL: 215mg/dl

LDL CHOL: 103mg/dl


(3)

390mg/dl

<200mg/dl

50%

-3 (.. 1g 2X2):
TRG 33%
TRG 258mg/dl

TRG 10- 20%


(4)

TRG 10- 20%

20% 30%

160 170 mg/dl

>500 mg

=200-500 mg

LDL
+

non HDL


(>500 mg/dl)

+
-3

<500 mg/dl

30-35%

 RG

30-50%

NIACIN

10-30%

10-30%

EZETIMIBE

5-10%

-3

20-50%

 15

, HTG
:
:

, :

+
-3
+

June 29, 2011

ESC/EAS Guidelines
for the management
of dyslipidaemias
EHJ & Atherosclerosis July 2011

+
:

-3

EUROPEAN SOCIETY OF CARDIOLOGY (ESC) AND THE

EUROPEAN ATHEROSCLEROSIS SOCIETY (EAS)
GUIDELINES FOR THE MANAGEMENT
OF DYSLIPIDEMIAS (2011)

MANAGEMENT OF MIXED DYSLIPIDEMIAS

A COMBINATION OF STATINS WITH FIBRATES CAN
ALSO BE CONSIDERED WHILE MONITORING FOR
MYOPATHY,
BUT
THE
COMBINATION
WITH
GEMFIBROZIL SHOULD BE AVOIDED

TRG

-37.6%

HDL CHOL

+14.9%

Non HDL CHOL

-9%

ATVB 2011;1716-1725

Triglycerides and CVD Factor Recent

Meta-Analysis of 29 Studies
N = 262 525
Groups

CHD Cases

Duration of follow-up
10 years

CHD Risk Ratio* (95% CI)

5902

<10 years

4256

Male

7728

Female

1994

Fasting status
Fasting

7484

Nonfasting

2674

Adjusted for HDL

Yes

4469

Sex

No

5689

Overall CHD Risk Ratio*

TRG 100mg/dl
70%

1.72 (1.56-1.90)
Decreased
Risk

Increased
Risk

Sarwar N, et al. Circulation. 2007;115:450-458.

TRIGLYCERIDES AND AMBUTATION RISK IN

PATIENTS WITH DIABETES
TEN-YEAR FOLLOW-UP IN THE DISTANCE STUDY


TRG 150-190mg/dl

1.10

TRG 200-499mg/dl

1.27

TRG > 500mg/dl

1.65
DIABETES CARE 2011;34:635-640

( / SLE)

(Per os)

- ( )

Isotretinoin

(protease inhibitors)
: ,

(5-10%)

20%

10-15%

(-3 )

5-10%

1-2% ( 1%

)
TRANS

1%( 1%


TRG
+++ ( TRG 20-30%)
+++ (<1-2
/10-30g/d)
+++
++
++
-3 ++
- +

DIETARY SUPPLEMENTS
AND FUNCTIONAL FOODS ACTIVE
ON PLASMA LIPID VALUES
: 2g/d LDL CHOL 7-10%
: LDL CHOL 3-5%

(, -) LDL CHOL
-3 : (2-4g) TRG 25-30%
POLCOSANOL AND RED YEAST RICE
CHOL

LDL

 RG

30-50%

NIACIN

10-30%

10-30%

EZETIMIBE

5-10%

-3

20-50%

HDL-C 20%,
2
(<5% ).
, ,
HDL-C .

 15

, HTG
:
:

, :

+
-3
+

June 29, 2011

ESC/EAS Guidelines
for the management
of dyslipidaemias
EHJ & Atherosclerosis July 2011

+
:

-3

EUROPEAN SOCIETY OF CARDIOLOGY (ESC) AND THE

EUROPEAN ATHEROSCLEROSIS SOCIETY (EAS)
GUIDELINES FOR THE MANAGEMENT
OF DYSLIPIDEMIAS (2011)

MANAGEMENT OF MIXED DYSLIPIDEMIAS

A COMBINATION OF STATINS WITH FIBRATES
CAN ALSO BE CONSIDERED WHILE MONITORING
FOR MYOPATHY, BUT THE COMBINATION WITH
GEMFIBROZIL SHOULD BE AVOIDED

TRG

-37.6%

HDL CHOL

+14.9%

Non HDL CHOL

-9%



n=64

(mg/dl)

6.81.2

FEUA (%)

83

4.91.4 ( 27.9%) 0.001

134 ( 62.5%)

0.01

Liamis et al: Am J Kidney Dis, 1999;34: 594

EUROPEAN SOCIETY OF CARDIOLOGY (EJC) AND THE

EUROPEAN ATHEROSCLEROSIS SOCIETY (EAS) GUIDELINES
FOR THE MANAGEMENT OF DYSLIPIDEMIAS (2011)

MANAGEMENT OF MIXED DYSLIPIDEMIAS

IF TRG ARE NOT CONTROLLED BY STATINS OR
FIBRATES PRESCRIPTION OF -3 FATTY ACIDS MAY
BE CONSIDERED TO DECREASE TRG FURTHER, AND
THESE COMBINATIONS ARE SAFE AND WELL
TOLERATED

 ,
.