Fast Facts: Hyperlipidemia

P. Durrington, A. Sniderman

Description

'Fast Facts: Hyperlipidemia' is a crisp and accurate summary of lipid disorders, with clear language and illustrations. Directed at a broad range of healthcare professionals, from primary care physicians to specialists, this updated sixth edition addresses the importance of considering lipoprotein particles, not just their lipids. The renowned authors, acknowledging the confusion surrounding the place of statins, carefully unpick clinical trial evidence and discuss guideline recommendations. The result is a clear and logical approach to the management of hyperlipidemia. Table of Contents: • Lipids and lipoprotein particles • Epidemiology and pathophysiology • Familial hypercholesterolemia • Polygenic hypercholesterolemia and combined hyperlipidemia • Hypertriglyceridemia • Familial dysbetalipoproteinemia • Dyslipidemia in insulin resistance, the metabolic syndrome and diabetes mellitus • Secondary hyperlipidemia • Dietary treatment • Drug treatment • When to treat • Biochemical tests

Sujets

• Médecine
• Hematology
• Médecine

Informations

• Publié par: S. Karger AG
• Date de parution: 26 janvier 2021
• Nombre de lectures: 0
• EAN13: 9783318067873
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Fast Facts: Hyperlipidemia First published 2000; second edition 2002; third edition 2005; fourth edition 2008, reprinted 2008; fifth edition 2010 Sixth edition 2021
Text 2021 Allan Sniderman, Paul Durrington 2021 in this edition S. Karger Publishers Ltd
S. Karger Publishers Limited, Elizabeth House, Queen Street, Abingdon, Oxford OX14 3LN, UK Tel: [phone]
Book orders can be placed by telephone or email, or via the website. Please telephone [phone] or email [e-mail] To order via the website, please go to karger.com
Fast Facts is a trademark of S. Karger Publishers Limited.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the express permission of the publisher.
The rights of Allan Sniderman and Paul Durrington to be identified as the authors of this work have been asserted in accordance with the Copyright, Designs Patents Act 1988 Sections 77 and 78.
The publisher and the authors have made every effort to ensure the accuracy of this book, but cannot accept responsibility for any errors or omissions.
For all drugs, please consult the product labeling approved in your country for prescribing information.
Registered names, trademarks, etc. used in this book, even when not marked as such, are not to be considered unprotected by law.
A CIP record for this title is available from the British Library.
ISBN 978-3-318-06786-6
Author: Sniderman, A (Allan) Fast Facts: Hyperlipidemia/ Allan Sniderman, Paul Durrington
Cover image: corneal arcus - a gray, white or yellowish ring or arc around the cornea (see pages 39-41 for more information).
Medical illustrations by Dee McLean, London, UK. Typesetting by Amnet, Chennai, India. Printed in the UK with Xpedient Print.
Contents
Abbreviations and glossary
Introduction
Lipids and lipoprotein particles
Epidemiology and pathophysiology
Familial hypercholesterolemia
Polygenic hypercholesterolemia and combined hyperlipidemia
Hypertriglyceridemia
Familial dysbetalipoproteinemia
Dyslipidemia in insulin resistance, the metabolic syndrome and diabetes mellitus
Secondary hyperlipidemia
Dietary treatment
Drug treatment
When to treat
Biochemical tests
Useful resources
Index
Abbreviations and glossary
ACC: American College of Cardiology
ACE: angiotensin-converting enzyme
Acetyl-CoA: acetyl coenzyme A
ACLY: ATP citrate lyase
AHA: American Heart Association
ALA: -linolenic acid
ALT: alanine transaminase
Android obesity: male-pattern obesity, characterized by increased accumulation of abdominal adipose tissue
ANGPTL3: angioprotein-like protein 3
Apo(a): apolipoprotein(a)
ApoA-I: apolipoprotein A-I, the major apolipoprotein in HDL
ApoB 48 : apolipoprotein B 48 , gut apolipoprotein B (its molecular weight is 48% of that of ApoB 100 )
ApoB 100 : apolipoprotein B 100 , hepatic apolipoprotein B
ApoC-II: apolipoprotein C-II, surface constituent of plasma lipoproteins and activator for lipoprotein lipase
ApoC-III: apolipoprotein C-III, component of triglyceride-rich VLDL and HDL in plasma
ApoE: apolipoprotein E, which associates with a range of lipoprotein particles and binds a number of cellular receptors, including the LDL receptor and LDL receptor-related protein
Apolipoproteins: structural proteins, often containing receptor-binding sites
ARH: autosomal recessive hypercholesterolemia
ASCVD: atherosclerotic cardiovascular disease
AST: aspartate transaminase
BMI: body mass index
CAC: coronary artery calcium (score)
CARDS: Collaborative Atorvastatin Diabetes Study
CETP: cholesteryl ester transfer protein (catalyzes transfer of cholesterol from HDL to circulating triglyceride-rich lipoproteins, and from LDL back to VLDL)
CHD: coronary heart disease
Cholesteryl ester: esterified cholesterol, which is more hydrophobic than free cholesterol
CNS: central nervous system
CRP: C-reactive protein
CT: computed tomography
CTT: Cholesterol Treatment Trialists
DHA: docosahexaenoic acid
EAS: European Atherosclerosis Society
EPA: eicosapentaenoic acid
ESC: European Society of Cardiology
FCHL: familial combined hyperlipidemia
FDB: familial defective ApoB
FH: familial hypercholesterolemia
Foam cell: a cell, usually a macrophage, the cytoplasm of which has become loaded with cholesterol
Gynoid obesity: female-pattern obesity, characterized by increased depots in the buttocks and other peripheral sites
HDL: high-density lipoprotein
HIV: human immunodeficiency virus
HMG-CoA: 3-hydroxy-3-methylglutaryl coenzyme A
HR: hazard ratio
HyperapoB: hyperapobetalipoproteinemia, elevated number of ApoB particles. Triglycerides, LDL-cholesterol and non-HDL-cholesterol may be elevated or normal
IDL: intermediate-density lipoprotein
ISA: intrinsic sympathomimetic activity
LCAT: lecithin-cholesterol acyltransferase, which catalyzes the esterification of free cholesterol
LDL: low-density lipoprotein
Lipemia retinalis: pallor of the optic fundus and white appearance of the retinal veins and arteries caused by extremely high levels of circulating chylomicrons
Lp(a): lipoprotein(a), an LDL-like particle that contains apolipoprotein(a) in addition to ApoB
LPL: lipoprotein lipase, an enzyme which breaks down triglycerides into fatty acids
LpX: lipoprotein X, an abnormal lipoprotein present in plasma in obstructive jaundice
LRP: LDL receptor-related protein
MTP: microsomal triglyceride transfer protein
NASH: non-alcoholic steatohepatitis (also known as non-alcoholic fatty liver disease)
NEFA: non-esterified fatty acids
NICE: National Institute for Health and Care Excellence
NNT: number needed to treat (to prevent one event)
PCE: pooled cohort equation
PCSK9: proprotein convertase subtilisin/kexin type 9
PPAR: peroxisome proliferator-activated receptor
SCORE: Systematic Coronary Risk Evaluation
Small dense LDL: cholesterol-depleted LDL (ApoB particles)
SR-BI: scavenger receptor class B, type I
TSH: thyroid-stimulating hormone
ULN: upper limit of normal
VLDL: very-low-density lipoprotein

A note on conversion of units
So that values will accord more closely with those chosen by various consensus groups, we have sometimes used a factor of 40, rather than the more precise 38.6, to convert between mmol/L and mg/dL as units of cholesterol concentration. Similarly, a conversion factor of 90 has been used for triglyceride. Converted values are given to two significant figures.
Introduction
Why is there a need for a sixth edition of Fast Facts: Hyperlipidemia ? The answer is that, first, there have been great advances in our understanding of hyperlipidemia and many more are waiting in the wings. Information about new drugs, a wider knowledge of how to use earlier ones and avoid side effects, improved means of diagnosis, the expanding role of genetics and much more are covered in this book. We have attempted to introduce these in a way that we hope will appeal to clinicians who wish to brush up on the subject and to those who may be coming to it with little prior knowledge (or interest, which we hope the book will arouse).
Second, probably more importantly, many aspects of hyperlipidemia continue to spark controversy in medical journals that frequently spills over into the lay press and social media. Much of the controversy is fueled by official guidance which, instead of digesting our accumulated knowledge and translating it objectively into practical information, adopts a peculiar logic leading to treatment paradigms that are bizarre and unfamiliar to doctors and nurses and their patients. The best lack all conviction, while the worst are full of passionate intensity. * The ensuing confusion has undoubtedly led to the inefficient deployment of statins and a failure to secure their full benefit in the prevention of atherosclerotic cardiovascular disease. This must be resolved and mistakes not repeated as our knowledge and the range of available treatments enter a new era.
A clear and logical approach to hyperlipidemia is thus our main justification for this new edition.
* From The Second Coming , WB Yeats.
1 Lipids and lipoprotein particles
Cholesterol and triglycerides are not soluble in water and must be transported from one tissue to another within lipoprotein particles. 1 - 4 Chylomicron particles transport triglycerides from the intestines to adipose tissue, skeletal and cardiac muscle and the liver, and cholesterol from the intestines to the liver. Very-low-density lipoprotein (VLDL) particles transport triglycerides from the liver to adipose tissue and skeletal and cardiac muscle. High-density lipoprotein (HDL) particles transport cholesterol from peripheral tissues to the liver.
The structure of a lipoprotein particle is illustrated in Figure 1.1 . A phospholipid monolayer makes up the outer membrane and cholesteryl ester and triglycerides make up the core. Apolipoproteins are the protein components; these differ in function and ability to leave one lipoprotein particle for another.
Lipoprotein particles
There are four key types of lipoprotein particle: chylomicrons and VLDL are the two triglyceride-rich lipoproteins, whereas low-density lipoprotein (LDL) and HDL are the two cholesterol-rich lipoproteins ( Figure 1.2