"48 SLIDES???!!", my friends shouted. A boring "48 slides" is depend on how you arrange it. And this is not the one for sure. I always love to prepare a short and sweet presentation. Or maybe long but sweet presentation? Oh yeah! Enjoy! #SLIDESKILLSvsSLIDEKILLS

1. DYSLIPIDAEMIA
NUR HANISAH BINTI ZAINOREN

2. THE PRESENCE OF AN ABNORMAL
LIPID PROFILE IN THE SERUM

3. CLASSIFICATION

4. 1) HYPERTRIGLYCERIDAEMIA
2) HYPERCHOLESTEROLAEMIA
3) MIXED HYPERLIPIDAEMIA
(ELEVATION OF BOTH)
CLASSIFICATION

5. 1) HYPERTRIGLYCERIDAEMIA
2) HYPERCHOLESTEROLAEMIA
3) MIXED HYPERLIPIDAEMIA
(ELEVATION OF BOTH)
CLASSIFICATION

6. 1) HYPERTRIGLYCERIDAEMIA
2) HYPERCHOLESTEROLAEMIA
3) MIXED HYPERLIPIDAEMIA
(ELEVATION OF BOTH)
CLASSIFICATION

7. 1) HYPERTRIGLYCERIDAEMIA
2) HYPERCHOLESTEROLAEMIA
3) MIXED HYPERLIPIDAEMIA
(ELEVATION OF BOTH)
CLASSIFICATION

8. CAUSES
PRIMARY
• Genetic causes
SECONDARY
• Nephrotic syndrome
• Hypothyroidism
• Type 2 diabetes
• Cholestasis
• Anorexia nervosa
• Drug-induced
• Hypertension
• Smoking
• Alcohol abuse

9. LIPID MEASUREMENTS ARE
USUALLY PERFORMED FOR
THE FOLLOWING REASONS:
• Screening for primary and
secondary prevention of
cardiovascular disease
• Investigation of patients with
clinical features of lipid
disorders and their relatives
• Monitoring of respond to diet,
weight control, and
medication

16. Elevated plasma
CHOLESTEROL causes
pathological changes in
the arterial wall,
leading to CAD

17. INCREASED CHOLESTEROL
BLOCKAGE OF ARTERIES
RISK OF CARDIOVASCULAR
DISEASES

18. MAJOR RISK
FACTORS
FOR CAD
• LDLC + HDLC
• LDLC : HDLC > 4
• Risk with increasing
cholesterol levels
(90% if >7.8 mmol/L)

20. 10%
reduction of
TOTAL
CHOLESTEROL
20%
reduction in
CAD
AFTER 3 YEARS

21. LDLC 1mg
decrease
reduces CHD
risk
by 1%
HDLC
1mg
increase
reduces CHD
risk
by 3%

22. INVESTIGATIONS
• Serum triglyceride level
• Serum cholesterol level
• HDLC & LDLC levels if cholesterol
>/= 5.5mmol/L
• TFTs if overweight elderly female
The following fasting tests are recommended in all adult
patients 18 years and over:

24. NON-PHARMACOLOGICAL
MEASURES

25. Keep to
ideal weight1

26. REDUCE fat intake
2

27. 3Replace saturated
fats with mono/poly-
unsaturated fats

28. Avoid biscuits
and cakes
between meals4

29. Always trim fat off
meat, remove skin
from chicken5

30. 6Eat fish at
least twice a
week

31. Regular
exercise7

32. Cessation of
smoking8

33. COOPERATION
of family is
essential9

34. PHARMACOLOGICAL
MEASURES

35. LIPID-LOWERING THERAPY
results in REDUCTION of
coronary and cerebrovascular
events with improved
survival

36. LIPID LOWERING DRUGS
STATINS
• Atorvastatin
• Pravastatin
• Simvastatin
• Fluvastatin
• Rosuvastatin
BILE ACID
BINDING RESINS
• Cholestyramine
• Colestipol
FIBRATES
• Gemfibrozil
• Fenofibrate
OTHER AGENTS
• Ezetimibe
• Nicotinic acid
• Probucol
• Fish oils n-3
fatty acids

37. The DECISION TO COMMENCE DRUG
THERAPY should be based on AT LEAST
TWO SEPARATE MEASUREMENTS at an
accredited laboratory
Be careful with beta-blockers and diuretics
affecting lipid levels

38. THE CHOICE OF THE LIPID-
LOWERING AGENT
DEPENDS ON THE PATTERN
OF THE LIPID DISORDER.

40. HYPERCHOLESTEROLEMIA
FIRST-LINE AGENTS
1. HMG-CoA reductase inhibitor
(statins)
– Atorvastatin, Fluvastatin,
Simvastatin, Pravastatin,
Rosuvastatin
2. Ezetimibe (if statin-tolerant)
3. Combination (ezetimibe +
statin)
4. Bile acid sequestrating resins
(e.g. cholestyramine)
5. Fibrates (consider if above drugs
not tolerated)
SECOND-LINE AGENTS
1. Nicotinic acid
2. Probucol
3. Oestrogen (can reduce
LDLC)

41. RESISTANT LDLC ELEVATION
1. Combination statin + ezetimibe
2. Combined statin + resin cholestyramine

42. MODERATE TO SEVERE TG ELEVATION
Gemfibrozil / Fenofibrate
OR
Nicotinic Acid
OR
N-3 fish oil concentrate 6g daily in divided
doses to max.15g/day

43. MASSIVE HYPERTRIGLYCERIDEMIA
Fibrate + fish oil

44. MIXED HYPERLIPIDAEMIA
Consider combination therapy, e.g.:
• Fish oil + statin
• Fibrate + resin
( TG + LDLC)
If TG < 4 : a statin
If TG > 4 : a fibrate

45. Length of treatment: possibly lifelong (upto 75 years)
Follow-up investigations:
– Serum lipids
– LFTs (ALT and CPK)
– Possibly CK

46. REFERENCE