hyperlipidaemia

hyperlipidaemia

a major risk factor for coronary heart disease
1. IDn & Rx during childhood may delay onset of CVD in later life
screen kids if at increased risk
1. parent or grandparent w/ hx of CHD before 55 years
2. fam hx of lipid disorder
if high serum cholesterol (i.e. >5.3 mmol/L) on random testing
1. measure triglyceride, LDL & HDL
secondary causes
1. obesity
2. hypothyroidism
3. diabetes mellitus
4. nephrotic syn
5. obstructive jaundice
familial hypercholesterolaemia
1. autosomal dominant
2. pathology
  1. defect in LDL receptor
3. incidence
  1. 1 in 500
4. associations
  1. premature coronary heart disease
    1. occurs in 50% by 50 years in males and by 60 years in females
5. clinical features
  1. xanthomata
    1. skin
    2. tendon
    3. uncommon in childhood
6. Mx
  1. drug therapy
    1. age= 10 years or more
    2. fam hx of premature CHD (< 55 yrs old)
    3. evidence of tissue lipid deposition
      1. xanthomata
      2. bruits
    4. non-lipid risk factors
      1. eg. diabetes
    5. bile acid sequestrants
      1. moderately effective
      2. compliance issues
    6. statins (HMG-CoA reductase inhibitors)
      1. effective
      2. no -ve effects on growth, maturation or endocrine function
    7. fenofibrate (fibrate)
      1. well tolerated-kids & teens
7. homozygous genotype
  1. very rare
  2. very severe
    1. xanthomata in childhood
    2. cardiovascular disease in the 20s
  3. refer to specialist centre
  4. Mx
    1. drug
      1. response varies acc to gene mutation
    2. liver transplant

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	Criado por v.djabatey mais de 10 anos atrás