Cholesterol

Question 1

When is cholesterol screening done?

Answer 1

every 5 years once a person turns 20 years old

Start sooner and screen more frequently for patients who are obese and/or with a family history of hypercholesterolemia.

Question 2

Why is cholesterol so important?

Answer 2

it is a modifiable risk factor for atherosclerosis, which is involved in about 50% of all deaths in the US and 1/3 of deaths between ages of 35-65, is the most important cause of permanent disability, and accounts for more hospital days than any other illness

Question 3

What physical findings will clue you into hypercholesterolemia? 5

Answer 3

Xanthelasma
^{(soft, yellow plaques involving the lower eyelid)}

Tendon xanthomas
^{(cholesterol deposits in the skin, classically over tendons in the lower extremities)}

Corneal arcus in younger patients

“milky”-appearing serum

obesity

Question 4

What are the current recommendations for management of cholesterol levels?

Answer 4

LDL is usually the deciding factor for treatment decisions:

Question 5

List the major risk factors for coronary heart disease (CHD).

Answer 5

• Age (men > 45; women > 55, or with premature menopause and no estrogen replacement therapy).
• Family history of premature heart attacks (MI or sudden death in father or first degree male relative < 55 or mother or first degree female relative < 65)
• Smoking
• HTN (≥140/90 mm Hg or on anti-HTN meds)
• Diabetes mellitus
• Low HDL (<40 mg/dL)
  
  • HDL >60 mg/dL is considered protective and negates one risk factor

Question 6

How is LDL calculated?

Answer 6

LDL = total cholesterol - HDL - TG/5

Question 7

Describe the treatment for hypercholesterolemia.

Answer 7

1. start with lifestyle modifications - always - before initiating drug therapy
2. HOWEVER, if the patient has CAD or CAD-equivalent (DM, PVD) + LDL >100, then initiating drug therapy is indicated
   
   • 1st line: HMG CoA reducatse inhibitor
   • 2nd line: niacin, ezetimibe, cholestyramine (bile acid-binding resin)

Question 8

How is HDL affected by alcohol?

Estrogens?

Exercise?

Smoking?

Progesterone?

Answer 8

alcohol: increase (moderate intake), decrease (excess intake)
exercise: increase
estrogen: increase
smoking: decrease
androgens: decrease
progesterone: decrease
hypertriglyceridemia: decrease

Question 9

What causes hypercholesterolemia?

Answer 9

Genetics + multifactorial:

western diet, inactive lifestyle

uncontrolled diabetes

hypothyroidism

uremia

nephrotic syndrome

obstructive liver disease

excess alcohol intake (increases TG)

medications (OCs, steroids, thiazides, ß blockers)