Hypercholesterolemia
Dr. Magnolia Reyes
OUTLINE
A. Case
B. Evaluation of patients with High
blood Cholesterol level
C. Management
D. ATP III Guidelines
Case:
• A 24 yr old man comes in for a routine
health check-up. He has no specific complaint
today. He has HPN and takes Hydrochlorothiazide.
He has no other significant medical history. He
does not smoke cigarettes, occasionally drinks
alcohol, and does not exercise. His father died of
heart attack at 60 and his mother died of cancer at
72 yrs old. He has 2 younger sisters who are in
good health. On his PE, his BP is 130/80mmHg,
PR 75bpm.
• He is 6 ft tall and weighs 200 lbs. his
complete PE is normal and his fasting lipid panel
shows TC 242mg/dL, TG 138mg/dL, HDL 48mg/dL,
and LDL 155mg/dL
1.) What is your diagnosis?
2.) What are the indications for statin therapy?
3.) What other laboratory testing is indicated at
this time?
4.) What is the recommended management at
this point?
Evaluation of patients with High blood
Cholesterol
• Cholesterol is not a disease
• High cholesterol is a risk factor for Coronary
Artery Disease (CAD)
• An individual’s cholesterol levels must be
interpreted in the context of their overall CAD
• The higher one’s risk, the higher is the intensity of
the statin therapy.
• Statin therapy is indicated in all patients.
ANG / HERNANDO / LEJAO / PASCUA E.
Clinical Therapeutics| PRELIMS (1st Sem)
EVALUATION:
• Blood cholesterol is high investigation
should evaluate for secondary causes of
dylipidemia.
• Diabetes, hypothyroidism, obstructive liver
disease and chronic renal disease.
• Work-up: Fbs, TSH, Liver enzymes, and
Creatinine level
• Certain Meds: progestins, anabolic steroids,
and corticosteroids.
MANAGEMENT:
• TLC (Therapeutic Lifestyle change) is the
cornerstone of all treatments for
dyslipidemia.
• Education on healthy living- dietary
modification, increased physical activity,
smoke cessation, weight reduction.
• Pharmacotherapy is considered with
patients ASCVD risk greater than 7.5% for
ACC/AHA10% for NICE
• With known CHD statin therapy is
recommended in all guidelines
• The first line pharmacotherapy for
cholesterol reduction is “Statin”
• It reduces the rates of coronary events,
strokes, cardiac deaths and all-cause
mortality.
• Ezetimibe is a second therapy for those who
can’ tolerate statins or have contraindication
to statin.
ATP III Guidelines
(AT THE APPENDIX)
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Dr. MAGNOLIA REYES
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