Dyslipidemia

Gene Terkoski
PharmD Candidate 2015
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Objectives
Define the pathophysiology of dyslipidemia
Describe the secondary effects of dyslipidemia
Identify at risk patients
Counsel patients on how to treat their disease
Thoroughly understand medication options available
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At the conclusion of this presentation, the participants will be able to:
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Description
At normal levels, cholesterol plays an important
role in helping cells perform their jobs.
When the levels become abnormal, dyslipidemia
occurs.
Liver produces 75% of the cholesterol
25% comes from food


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Description
Dyslipidemias often manifested by
- Elevation low-density lipoprotein (LDL) cholesterol
- Elevated triglyceride concentrations
- Low high-density lipoprotein (HDL) cholesterol concentration
Dyslipidemia occurs as a result of many disease
states including diabetes.
From dys- + lipid (fat) + -emia (in the blood) =
essentially, disordered lipids in the blood.



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Cholesterol
Up to a third of blood cholesterol is
carried by high-density lipoproteins
(HDL). This is called good
cholesterol because it helps
remove bad cholesterol,
preventing it from
building up inside the
arteries.
.

Total cholesterol
measures the combination
of LDL, HDL, and VLDL (very low
density lipoprotein) in your bloodstream.
VLDL is a precursor of LDL, the bad
cholesterol.
Most of the cholesterol in the blood is
carried by low density lipoproteins
(LDL). This is known as the bad
cholesterol because it combines
with other substances to clog
the arteries.
The body converts
excess calories, sugar,
and alcohol into
triglycerides, a type of fat
that is carried in the blood
and stored in fat cells throughout
the body.
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Etiology/Cause
High Cholesterol comes from two sources
- Genetics
- Diet
o Saturated fat and cholesterol occur in animal-based
foods, including meat, eggs, and dairy products
made with milk.
- In many cases, high cholesterol stems from a
combination of diet and genetics.

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Other Causes of Dyslipidemia
Causes of hypertriglyceridemia
Drinking alcohol
Obesity, diabetes
Some medications
Estrogen
Glucocorticoids


Causes of hypercholesterolemia
Hypothyroidism
Pregnancy
Kidney failure
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Why Dyslipidemia Matters

Atherosclerosis!
- Build up of plaque
Leads to
- Coronary Heart Disease
- Angina
- MI
- Stroke
- Pulmonary Embolism
- Peripheral Artery Disease
Appears to boost the risk of Alzheimer's disease

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Diagnosis
High/Abnormal lipid levels are often undiagnosed
Screening/ Testing
Recommended that screenings
start before age 35 in men &
before age 45 in women
Adults with diabetes should
tested annually
Cholesterol Test
LDL: 70-130 mg/dL
HDL: more than 40-60 mg/dL
Total cholesterol: less than
200 mg/dL
Triglycerides: 10-150 mg/dL
.


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Treatment Options Lifestyle Adjustments
A healthy diet should consist of healthy fats
such as those found in olive and canola oils,
nuts, seeds and fish.
Limit intake of saturated fats such as those
found in dairy and animal products; they are
also high in cholesterol.
Exercise is important for managing lipid levels.
Losing excess weight can treat your
hyperlipidemia by lowering excess amounts of
lipids and other fats as well as raising your
level of "good" cholesterol.

An important part of treatment is lifestyle changes, of which diet is one of
the most important.
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Treatment Options- Medications
.


Statins
Statins are usually the
first choice. They block
the production of
cholesterol in the liver.
Examples include Crestor
and Zocor
Statins may cause muscle
damage when they are
used with other
medications.
Fibrates
This classification of
medication binds lipids to
bile, a necessary
component of digestion.
Examples include
Colestid
May Cause constipation
or reduce the absorbtion
of lipid soluble vitamins.

Bile-Binding Medications
If lifestyle adjustments do not achieve the desired lipid levels, then taking
medication becomes essential
Hypertriglyceridemia is
usually treated with a
group of medications
called fibrates.
Examples include Tricor

Fibrates are effective but
may cause GI disturbance
or rash.
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Ezetimibe

MOA: inhibits absorption of cholesterol in the
small intestine
Indication: Hypercholesterolemia
ADRs: Diarrhea, fatigue, arthralgia, liver toxicity
Combination products available

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Treatment: Supplements and Herbs
Supplements
Flaxseed or fish oil
Plant sterols, such as beta-
sitosterol.
Prescription niacin, a B-
complex vitamin
Niacin found in ordinary
supplements should not
be used to lower
cholesterol.

Herbs
Fenugreek seeds
Artichoke leaf extract
Yarrow
Holy basil
Garlic
Garlic pills can have
side effects and may
interact with some
medications

Certain dietary supplements and herbs may also improve cholesterol levels.
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Successful Treatment of Dylipidemia
Diagnosis
Lifestyle
Change
Drugs
Lower
Lipid
Levels
Prevention of
Atherosclerosis
Physician Diagnosis
Step by Step Process
Second Line of Therapy Damage Minimized or Avoided
First Line of Therapy Result of Therapy
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Future Trends-Research

316 currently open studies on dyslipidemia, as reported
by ClinicalTrials.gov
Some of the studies are looking at:
- The Safety, Tolerability and Pharmacokinetics of a new drug, TAP311
- The Efficacy, Safety of extended release statin compounds
- The Efficacy, Safety of co-administered Pitavastatin and Valsartan since
hyertension and dyslipidemia frequently concurrence in the same
patient population
- The Safety and Efficacy of adding Anacetrapib (MK-0859) to ongoing
statin therapy
- Almonds, Oats, and Magnesium are foods or/and supplements being
also being studied for effectiveness in this condition

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Future Trends-An Interesting Approach

A Community Based Approach to Dyslipidemia Management:
Pharmacist Prescribing to Achieve Cholesterol Targets (RxACT)
- ClinicalTrials.gov Identifier: NCT01581372
- Study being run through the University of Alberta in Canada
Background:
- The Canadian Health Measures survey, which was conducted from
2007-2009, found that roughly 36% of Canadians had unhealthy levels
of LDL.
- Pharmacists are front-line primary care professionals who see patients
at risk for cardiovascular disease more frequently than other healthcare
professionals.
- Pharmacists have the opportunity to systematically and proactively
identify patients with undertreated dyslipidemia, as one public health
approach to chronic disease management.


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Future Trends-Research

A Community Based Approach to Dyslipidemia Management:
Pharmacist Prescribing to Achieve Cholesterol Targets (RxACT)

Objectives:
- To evaluate the effect of enhanced pharmacist care (i.e., assessment,
care plan development, education/counseling, prescribing/titration of
lipid-lowering medications and close follow-up) on participants achieving
target cholesterol levels.

Design:
- Randomized controlled trial of enhanced pharmacist care
- Conducted in community pharmacies in Alberta
- Target population adults with uncontrolled dyslipidemia
- The primary invention will be pharmacist directed dyslipidemia care


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So What Can You Do As a Healthcare Provider?
Prevention is easier than the treatment
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Review of Objectives
Define the pathophysiology of dyslipidemia
Describe the secondary effects of dylipidemia
Identify at risk patients
Counsel patients on how to treat their disease
Thoroughly understand medication options available
1
2
3
4
5
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Thank you for the opportunity
to interview
Do You Have
Any Questions?