After finishing the section on cholesterol in Swanson's, I figured it would be a good exercise to rewrite my notes from the section. So heeeere we go!...
Screen all men over 35 and women over 45, or at 20 if they have risk factors for heart disease.
CAD risk factors
1) HTN
2) smoking
3) DM
4) men 45 or older, women 55 or older
5) FamHx of MI in a man 55 or younger or in a woman 65 or younger
Obesity is not a specific risk factor, but there are strong association
Total cholesterol should be at or less than 200 mg/dL, and above 240 is considered elevated. The LDL should be at or below 130 mg/dL (or 100 mg/dL if there are at least 2 risk factors). The HDL should be at or greater than 40 mg/dL, or 50 mg/dL if the patient is a premenopausal woman. If the HDL is 60 or greater, you can subtract 1 risk factor from the patients' risk stratification.
AHA step I and II diets are considered the treatment of choice for high cholesterol. The step I diet is a diet containing < 30% calories from fat, < 10% calories from saturated fat, and less that 300 mg per day of cholesterol. The step II diet drops the calories from saturated fats to <7% and the total cholesterol to <200 mg per day.
The best drug for high LDL is a statin. It can lower LDL by 40% and triglycerides by 10-15%. Make sure to check plasma lipids and LFTs at 3 months and 6 months.
The second line drug is niacin. It can decrease LDL by 35%, triglycerides by 75%, ApoA by 50%, and increase HDL by 100%. LFTs and CK needs to be checked monthly for 3 months, then at 6 months and a year. Some of the side effects (GI, flushing, etc) can be alleviated if you take the niacin with aspirin.
The third choice is cholestyramine (bile acid sequestrants).
Hypertriglyceridemia is an independent risk factor for CAD, but there are secondary causes such as DM, alcohol, and OCDs. The drug of choice is gemfibrozil BID.
LDL= TC - (Trig's/5 + HDL)
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