By: Maged Taman
1- Adults 20 years old or more should have fasting lipid profile. If normal they can retested at least once every 5 years.
2- Lipid profile is fasting Total cholesterol, triglycerides, LDL (bad cholesterol and HDL (good cholesterol).
3- Lipid profile assessment:
Total cholesterol: <200>150 normal (preferable <100>140/90 or in blood pressure medicine.
Low HDL
Family history of premature CAD: father, brother or son <55>45 years old and women >55 years old.
HDL > 60 cancells one of the above risk factors.
5- CAD equivalents: these are other astherosclerotic manifestations that lead to same risks of CAD death and nonfatal MI like that of established CAD. They are:
peripheral vascular disease
Abdominal Aortic aneurysm.
Carotid artery disease.
Diabetes Mellitus.
10-year risk> 20%
6- LDL and non HDL goals:
CAD or CAD equivalents:
LDL goal is <100>100 or even >70
Non-HDL goal (total cholesterol - HDL) <130>130
drug for LDL > 130 and 10 year risk of 10-20%
Drug for LDL >160 and 10 year risk is <10> 160
Drug for LDL > 190
Non-HDL goal <190
7- Statins are the drug of choice for above patients decreases LDL 20-60%, resins 15-30 %, nicotinc acid 10-25 %, fibrates 5-20%, cholesterol absorption blocker Zetia 17%.
8- Patients with premature CAD and normal lipid profile: check LP (a), apo B and homocysteine.
