Control of Dyslipidemia

Ki-Hoon Han

doi:10.5124/jkma.2009.52.3.299

J Korean Med Assoc > Volume 52(3); 2009 > Article

Han: Control of Dyslipidemia

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2009; 52(3): 299-311.

Published online: March 31, 2009

DOI: http://dx.doi.org/10.5124/jkma.2009.52.3.299

Control of Dyslipidemia

Ki-Hoon Han, MD

Department of Internal Medicine, University of Ulsan College of Medicine, Korea. steadyhan@amc.seoul.kr

Abstract

Lipid particles, which can be synthesized in the liver or absorbed through the terminal ileum, are indispensable for maintaining homeostasis. Inadequate life styles together with certain types of genetic background can induce and aggravate the condition of dyslipidemia. The personal status of inflammation, which is reflected by the serum C-reactive protein level, and the status of insulin resistance are considered as emerging risks for cardiovascular diseases. Therefore, together with aggressive management of correctable major risks, maintaining ideal lifestyles may be helpful to prevent the event of cardiovascular diseases. The most important goal of managing dyslipidemic conditions is to reach an ideal level of lipid profile, and aggressive drug management can be tried where indicated.

Dyslipidemia; Metabolic syndrome; Statins; Cardiovascular disease

Acknowledgements

This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government(MOST) (No. M10748000263-07N4800-26310). KH Han and SH Lim were in part supported by grant A050020 from the Korean Ministry of Health and Welfare, 2009-288 from the Asan Institute for Life Sciences and by the Cardiovascular Research Foundation, Seoul, Korea.

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Figure 1

Lipid metabolism: VLDL-IDL-LDL pathway.

Figure 2

Lipid metabolism: HDL pathway.

Figure 3

Risk assessment in primary prevention of cardiovascular disease (CVD); The effects of high-Sensitivity C-reactive protein and the ratio of total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C)

Figure 4

Change of lipid metabolism due to insulin resistance.

Figure 5

LDL particle size and apolipoprotein B predict ischemic heart disease: Quebec Cardiovascular Study.

Figure 6

Niacin metabolism (9).

Table 1

Major risk factors for candiovascular disease other than LDL cholestenol level (NCEP-III guideline)

^*Diabetes is regarded as a coronary heart disease (CHD) risk equivalent.

^†HDL cholesterol ≥ 60 mg/dL counts as a "negative" risk factor; its presence removes 1 risk factor from the total count.

Table 2

High risk group (NCEP-III guideline)

CHD: coronary heart disease

Table 3

Definition of metabolic syndrome (NCEP-III guideline) (≥ 3 factors fulfills the diagnosis)

^*Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated body mass index (BMI). Therefire, the simple measure of waist circumference is recommended to identify the body weight component of the metabolic syndrome.

^†Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, eg, 94~102 cm (37~40 in) Such patients may have strong genetic contribution to insulin resistance and they should benefit from changes in life habits, similarly to men with categorical increases in waist circumference.

Table 4

Target goal of LDL cholesterol level

cf. CHD indicates coronary heart disease, LDL: low density lipoprotein

Table 5

Potency of statins and ezetimibe (EZ)

TC: total cholesterol, LDL-C: low density lipoprotein cholesterol, Rule of 5s & 7s: Total cholesterol and LDL cholesterol levels are reduced additionally by 5 and 7%, respectively if statin dose is doubled.

Table 6

Guideline of omega-3 fatty acid (AHA)

Kris-Etherton, Harris and Appel. Circulation. 2002; 106: 2747-2757.