RT Book, Section
A1 Rosenson, Robert S.
A1 Grundy, Scott M.
A2 Fuster, Valentin
A2 Harrington, Robert A.
A2 Narula, Jagat
A2 Eapen, Zubin J.
SR Print(0)
ID 1191187093
T1 HYPERLIPIDEMIA
T2 Hurst's The Heart, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071843249
LK accesscardiology.mhmedical.com/content.aspx?aid=1191187093
RD 2024/04/24
AB SummaryThis  chapter  discusses  the  causes  and  effects  of  hyperlipidemia,  as  well  as  treatment  strategies  for  the  condition  (see  accompanying  Hurst’s  Central  Illustration).  The  two  main  categories  of  hyperlipidemia  are  hypercholesterolemia  and  hypertriglyceridemia;  combined  hyperlipidemia  indicates  an  increase  in  concentration  of  both  cholesterol  and  triglycerides.  An  elevated  plasma  low-density  lipoprotein  (LDL)  level  is  considered  a  major  risk  factor  for  atherosclerotic  cardiovascular  disease  (ASCVD),  and  LDL-lowering  therapies  reduce  atherosclerotic  plaque  progression  and  the  likelihood  of  plaque  rupture  and  acute  ASCVD  events.  By  contrast,  high  levels  of  high  density  lipoprotein  (HDL)-cholesterol  are  associated  with  reduced  risk  of  ASCVD;  however,  to  date,  no  convincing  randomized  controlled  trial  data  have  demonstrated  that  raising  HDL-cholesterol  levels  prevents  the  condition.  Growing  evidence  indicates  that  very-low-density  lipoprotein  (VLDL),  and  possibly  cyclomicron  remnants,  are  also  atherogenic.  Several  genetic  defects  have  been  associated  with  hypercholesterolemia  and,  in  most  cases,  result  in  high  levels  of  LDL-cholesterol.  Similarly,  various  genetic  abnormalities  that  affect  VLDL,  VLDL  remnants,  and/or  chylomicrons  have  been  associated  with  hypertriglyceridemia.  Familial  combined  hyperlipidemia  is  likely  a  polygenic  disorder.  Secondary  causes  of  hyperlipidemia  include  diabetes  mellitus,  nephrotic  syndrome,  chronic  kidney  disease,  hypothyroidism,  human  immunodeficiency  virus,  and  various  medications.  Lifestyle  factors,  including  poor  diet,  obesity,  low  physical  activity  levels,  and  cigarette  smoking,  are  also  risk  factors  for  hyperlipidemia  and  ASCVD.  Therapies  shown  to  lower  lipid  levels  include  statins,  bile  acid  resins,  ezetimibe,  monoclonal  antibody  inhibitors  of  PCSK9,  mipomersen,  lomitapide,  fibrates,  niacin,  and  LDL  apheresis.