DYSLIPIDEMIA

1. Definition
a. Metabolic disorders characterized by elevations of fasting plasma LDL-
cholesterol, and/or triglycerides (TG), and/or low HDL-cholesterol
b. Abnormal elevation of plasma cholesterol or triglyceride levels

2. Lipid Transport
a. Lipoproteins :
i. Consist of lipid core surrounded by a shell of water-soluble cholesterol,
apoproteins, and phospholipids
ii. Transport lipids within the body
b. Apolipoproteins :
i. An enzyme co-factors
ii. Promotes clearance of the particle by interacting with cellular receptors
and stabilize the lipoprotein m cells

c.

3. Lipid Pathway
 a.

4. Assessment
a.
b. Ukur fasting serum TC, LDL-C, HDL-C, dan triglyceride
c. Screening with full fasting lipid profile
i. Males >40 yo
ii. Females >50 yo
iii. Menopausal
iv. Any age dengan RF dyslipidemia
d. Screening secondary causes
i. Hypothyroidism
ii. CKD
iii. DM
iv. Nephrotic syndrome
v. Liver dz
e. Risk category
 i. Estimate the model for 10 yr CAD risk developed dari Framingham Risk
Score

5. Risk factors

a.

6. Management
a. Health behaviours (can decrease LDL-C by up to 10%)
i. Smoking cessation : most important for preventing CAD
ii. Dietary modification :
1. Reduce saturated fat, red meat, refined sugar, alcohol
2. Increase consumption of nuts, fruits/vegetables, poultry, fish
iii. Physical activity : at least 50 mnn of moderate to vigorous intensity
aerobic exercise per week
iv. Apply lifestyle modification selama 3 bulan sebelum coba drug therapy
b. Pharmacotherapy (-40% LDL-c)
i. Statin - 1st line
1. Risk : myopathy and hepatotoxicity
2. Severe side effects → kasih ezetimibe
ii. Monitoring
1. ALT, CK, creatinine
iii. Primary prevention
1. Estimate 10 yr risk of CAD using Framingham Risk score
2. Establish treatment targets
3. Low FRS → no need statin
7. HYPERTRIGLYCERIDEMIA
a. Definition : Elevated Triglycerides
b. Types :
i. Primary

ii. Secondary
1. Etiology
 a. Endocrine : obesity/metabolic syndrom, hypothyroidism
(high LDL, not TG), acromegaly, Cushing’s syndrome, DM
b. Renal : CKD, liver dz, plyclonal and monoclonal
hypergammaglobulinemia
c. Hepar : CKD, hepatitis, glycogen storage dz
d. Drugs : alcohol, corticosteroid, estrogen,
hydrochlorothiazide, retinoid acid, beta blockers w/o ISA,
anti-retroviral drugs, atypical antipsychotics, oral
contraceptive pills
e. Other : pregnancy

8. Isolated Hypertriglyceridemia
a. Gak increase cardiovascular risk
b. Normal HDL-C and TC ; elevated TG
c. Principal therapy : lifestyle modification
d. Drug therapy
i. Nicotinic acid
ii. Fibrates

9. HYPERCHOLESTEROLEMIA
a. Primary

i.
b. Secondary
i. Etiology
 1. Endocrine : hypothyroidism
2. Renal : nephrotic syndrome
3. Immunologic : monoclonal gammopathy
4. Hepar : cholestatis liver disease (primary biliary cirrhosis)
5. Nutritional : diet, anorexia
6. Drugs : cyclosporin, anabolic steroids, carbamazepine

10. LOW HIGH-DENSITY LIPOPROTEIN

a. Primary

i.
b. Secondary
i. Etiology
1. Endocrine : obesity / metabolic syndrome, DM
2. Drugs : beta blockers, benzodiazepines, anabolic steroids
3. Other : acute infections, inflammatory conditions

11. DYSLIPIDEMIA and the RISK for CAD

a. Definition
i. Increased LDL is a major risk factor for atherosclerosis and CAD as LDL
isi the major atherogenic lipid particle
ii. Increased HDL is associated with decreased cardiovascular dz and
mortality
iii. Moderate hypertriglyceridemia (2.3 - 9 mmol/L) is an independent RF for
CAD, especially in people with DM and in post-menopausal women
b. Screening
i. Men >40 yo ; women >50 yo or post-menopausal
ii. RF in any age :
1. DM
2. Smoking or COPD
3. HTN
4. Obesity - BMI >27
5. Family history of premature CAD
 6. Clinical signs of hyperlipidemia (xanthelasma, xanthoma, arcus
cornealis)
7. Evidence of atherosclerosis
8. Inflammatory dz
9. HIV
10. CKD
11. Erectile dysfunction
iii. Children with a family history of hypercholesterolemia or chylomicronemia
c. Factors affecting risk assessment
i. Metabolic syndrome
ii. Apolipoprotein B (apo B)
iii. C-reactive protein levels

12. Metabolic Syndrome

a. Symptoms
i. Central obesity
ii. Men : waist circumference >= 94 cm
iii. Women : waist circumference >=80 cm
iv. + any 2 of the RF

1.