原文

Prevention and Screening

What preventive lifestyle measures should clinicians recommend to reduce risk for dyslipidemia?

Who should be screened?

How and how often should clinicians screen for dyslipidemia?

Diagnosis

How should clinicians interpret results of lipid screening in relation to evaluating overall cardiovascular risk?

What laboratory tests results should clinicians obtain before starting therapy?

  • T-CHO
  • LDL-C
  • HDL-C
  • TG
  • 考慮: apolipoprotein (a), apolipoprotein B, apolipoprotein A1
  • 血脂最好空腹12小時，不過，空腹與否不太影響T-CHO及HDL-C

How should clinicians measure and interpret triglyceride and HDL-C levels?

Triglyceride levels

  • TG為CAD的independent risk factor, 女性更強烈

HDL-C levels

  • 會低多半來自secondary原因, 比如β-blockers和androgenic steroids

What should clinicians look for in the history and physical examination?

  • Drugs
  • CV risks

What are the causes of secondary dyslipidemia, and how should clinicians diagnose them?

  • Drugs
  • Hypothyroidism
  • Obstructive liver disease
  • Nephrotic syndrome
  • Renal failure
  • Uncontrolled DM
  • Tobacco
  • Alcohol

When should clinicians consider specialized lipid tests or referral to a specialist?

  • Very high LDL-C with premature atherosclerosis

Treatment

What should clinicians advise patients with dyslipidemia about lifestyle changes?

  • 可降LDL-C 5-15%
  • 少吃紅肉及動物性油脂

When should clinicians recommend drug therapy?

  • 臨床試驗根據clinical risk，而非血脂criteria

What options are available for drug therapy?

  • Statins以外的藥，都只有搭配statin下才有被證實可減少CVD risk

When is combination drug therapy warranted?

  • 當statin用到最大劑量而仍未達標時

What are the therapeutic goals of treatment?

  • 生活型態改變
  • 心血管風險下降

How should therapy be monitored?

  • 至少吃6個月才能減少CVD risk，而服藥通常要一輩子
  • 六週後追蹤看初步療效

What are the side effects of drug therapy?

  • Statins最常見：myalgia, myositis, elevated LFTs

What should clinicians advise patients about the use of complementary–alternative therapies?

  • 在高風險患者仍無法取代藥物

When should clinicians consult a lipid specialist?

What measures do U.S. stakeholders use to evaluate the quality of care for patients with dyslipidemia?

What do professional organizations recommend regarding the care of patients with dyslipidemia?