Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypercholesterolemia 743

Specific Diagnostic Tests

■Apolipoprotein B

■Apolipoprotein E genotype

Imaging

■none

differential diagnosis

■Familial hypercholesterolemia

■Polygenic hypercholesterolemia

➣Secondary causes:

Hypothyroidism

Nephrotic syndrome

Dysglobulinemia

Glucocorticoid excess

Hepatic cholestasis

Anorexia nervosa

■Familial combined hyperlipidemia (elevated cholesterol and triglyc-

eride in patient or in various family members)

■Dysbetalipoproteinemia (elevated cholesterol and triglyceride with

apolipoprotein E2 genotype)

■Hyperalphalipoproteinemia (isolated elevated HDL cholesterol)

management

What to Do First

■Establish whether secondary causes and treat those

■Assess cardiovascular risk factors

➣Men >45 years

➣Women >55 years

➣Family history of premature cardiovascular disease (<55 in male

or <65 in female first-degree relative)

➣Current smoking

➣Hypertension

➣Diabetes mellitus

➣HDL cholesterol <40 mg/dl (≥60 mg/dl is a negative risk factor)

General Measures

■Diet: reduce saturated fat (10%), total fat intake <30% of calories,

weight loss if indicated

■Regular exercise

■Treatment goals

➣Primary Prevention