💥The Ultimate Guide to Lipids💥
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines
🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
1/ Lipid Biology #ACC21 #ACCMedStudent
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein
Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein
Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
2/ Lipid Biology continued...#ACC21 #ACCMedStudent
HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport
Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport
Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
3/ Physical Exam Clues #ACC21
Xanthomas, corneal arcus➡️FH
⚡️Sitosterolemia (📈intestinal absorption & decreased biliary excretion of sterols) can appear similar to xanthomas
Palmar Xanthomas➡️Type III hyperlipidemia (recessive, defective removal of VLDL & chylomicron remnants)
Xanthomas, corneal arcus➡️FH
⚡️Sitosterolemia (📈intestinal absorption & decreased biliary excretion of sterols) can appear similar to xanthomas
Palmar Xanthomas➡️Type III hyperlipidemia (recessive, defective removal of VLDL & chylomicron remnants)
4/ Physical Exam Clues continued... #ACC21
🍊orange tonsils➡️Tangier disease (mutation in ABCA1, HDL deficiency), associated w/ hepatosplenomegaly, atherosclerosis, polyneuropathy, elevated TG
👀cloudy cornea➡️Fish-eye disease (mutation in LCAT gene, low HDL, inc VLDL/TG).
🍊orange tonsils➡️Tangier disease (mutation in ABCA1, HDL deficiency), associated w/ hepatosplenomegaly, atherosclerosis, polyneuropathy, elevated TG
👀cloudy cornea➡️Fish-eye disease (mutation in LCAT gene, low HDL, inc VLDL/TG).
5/ Lipid Tests & Interpretation #ACC21 #ACCMedStudent
When to measure Lp(a)?
🔶Family hx of premature ASCVD
🔶Premature ASCVD
🔶LDL >190, suspected FH
🔶Very high ASCVD risk to better define benefit from PCSK9i
When to measure Lp(a)?
🔶Family hx of premature ASCVD
🔶Premature ASCVD
🔶LDL >190, suspected FH
🔶Very high ASCVD risk to better define benefit from PCSK9i
6/ CV Risk Assessment
Guidelines recommend use of pooled cohort equations (PCE) for 10-year ASCVD risk
🛑Can under- and over-estimate risk in some populations➡️consider risk-enhancing factors
🛑May use CAC score in risk assessment & treatment decision
Guidelines recommend use of pooled cohort equations (PCE) for 10-year ASCVD risk
🛑Can under- and over-estimate risk in some populations➡️consider risk-enhancing factors
🛑May use CAC score in risk assessment & treatment decision
7/ Fundamentals of Lipid Management #ACC21
Diet & Exercise are always🔑
➕soluble fibers, nuts, vegetable protein, DASH diet
🚫refined carbs, processed foods
LDL >70 despite statins:
Ezetimibe (IMPROVE-IT)
PCSK9i (FOURIER & ODYSSEY)
Bempodeic acid (pending outcome trials)
Diet & Exercise are always🔑
➕soluble fibers, nuts, vegetable protein, DASH diet
🚫refined carbs, processed foods
LDL >70 despite statins:
Ezetimibe (IMPROVE-IT)
PCSK9i (FOURIER & ODYSSEY)
Bempodeic acid (pending outcome trials)
8/ Review of guidelines #ACC21
♦️Emphasize heart-healthy lifestyle
♦️Clinical ASCVD➡️max tolerated statin to📉LDL by >50%
♦️Very high-risk ASCVD➡️threshold of 70mg/dL for non-statin
♦️LDL-C>190➡️high-intensity statin
♦️40-75 yo w/ diabetes & LDL-C>70➡️moderate-intensity statin
♦️Emphasize heart-healthy lifestyle
♦️Clinical ASCVD➡️max tolerated statin to📉LDL by >50%
♦️Very high-risk ASCVD➡️threshold of 70mg/dL for non-statin
♦️LDL-C>190➡️high-intensity statin
♦️40-75 yo w/ diabetes & LDL-C>70➡️moderate-intensity statin
9/ Review of guidelines continued... #ACC21 #ACCMedStudent
♦️40-75 yo primary ASCVD prevention➡️risk discussion
♦️40-75 yo w/o diabetes, LDL>70 + 10-yr risk >7.5%➡️moderate-intensity discussion if risk discussion favor Rx
♦️Assess response w/ repeat lipids 4-12 weeks after Rx
♦️40-75 yo primary ASCVD prevention➡️risk discussion
♦️40-75 yo w/o diabetes, LDL>70 + 10-yr risk >7.5%➡️moderate-intensity discussion if risk discussion favor Rx
♦️Assess response w/ repeat lipids 4-12 weeks after Rx
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