hyperlipidaemiák szollár lajos klinikai kórélettan 2006. szeptember 28
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The path of normal lipid metabolismTRANSCRIPT
Hyperlipidaemiák
Szollár LajosKlinikai kórélettan
2006. Szeptember 28.
Metabolic pathways for endogenous and exogenous
lipids
The path of normal lipid metabolism
Reverse cholesterol transportReverse Cholesterol Transport
Peripheraltissuestissues
CellCellmembranemembrane
VLDL, IDL, LDLVLDL, IDL, LDL
LDLLDL receptorreceptor
LCATLCAT CETPCETPFCFC
CECECECE
TGTGHDLHDL HDL3HDL3
TGCE
Free cholesterolTriglyceridesCholesteryl esters
CETP Cholesteryl ester transfer proteinLCAT Lecithin cholesterol acyltransferase
SRB1SRB1
FC
ABCA1ABCA1
LiverLiver
HDL metabolism and reverse cholesterol transport
Regulation of cholesterol biosynthesis
LDL receptor
structure-function
relationship
A Utah pedigree with familial
hypercholestolaemia
Prevalence of tendon xanthomas and full circumference corneal arcus in
354 Utah patients
Factors altering the course of cardiovascular
disease
NCEP ATP III Guidelines (2004 proposed modifications)
Grundy SM et al. Circulation 2004;110:227-239.
Patients with
High risk: CHD orCHD risk equivalents(10-year risk >20%)
Initiate TLC* if LDL-C
100 mg/dL†
Drug therapy considered if LDL-C
100 mg/dL(<100 mg/dL: drug optional)
LDL-Cgoal
<160 mg/dL†
<130 mg/dL†
(optional goal:<100 mg/dL†)
<100 mg/dL†
(optional goal:<70 mg/dL†)
†70 mg/dL = 1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L; 190 mg/dL = 5 mmol/L: * TLC: therapeutic lifestyle changes
Moderately high risk: >2 risk factors (10-year risk 10-20%)
Moderate risk: >2 risk factors (10-year risk <10%)
Lower risk: 0-1 risk factors
<130 mg/dL†
130 mg/dL†
130 mg/dL†
160 mg/dL†
130 mg/dL(100-129 mg/dL: drug optional)
160 mg/dL†
190 mg/dL†
(160-189 mg/dL: drug optional)
NCEP ATP III: LDL-C Goals (2004 proposed modifications)
*Therapeutic option in very high-risk patients and in patients with high TG, non-HDL-C<100 mg/dL; ** Therapeutic option; 70 mg/dL =1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160
mg/dL = 4.1 mmol/L
High RiskCHD or CHD risk
equivalents(10-yr risk >20%)
LDL-
C le
vel
100 -
160 -
130 -
190 -
Lower Risk
< 2 risk factors
Moderately High Risk≥ 2 risk factors
(10-yr risk 10-20%)
Target 160mg/dL
Target 130mg/dL
70 -
Target 100 mg/dL
or optional
70 mg/dL*
Moderate Risk
≥ 2 risk factors
(10-yr risk <10%)
Target 130 mg/dL
or optional 100
mg/dL**
Grundy SM et al. Circulation 2004;110:227-239.
LDL-koleszterin- szint egy nyugat-európai népességben:, fiziológiás
tartomány és terápiás célok.
Fiziológiástartomány
Célértékek
0.5 1.5 3.0 LDL-cholesterin mmol/L
Népesség frekvencia
2.51.8
Adapted from: O. Faergeman, S. M. Grundy. Dyslipidaemia. Elsevier. 2003
Impact of Recent Clinical Trials: Revised CAD Risk Categories
Estimate total CVD risk of fatal CVD event in 10 years
using SCORE chart
Total CVD risk <5%TC 5 mmol/L (190 mg/dL)
Total CVD risk 5% TC 5 mmol/L (190 mg/dL)
Measure fasting lipids, give lifestyle advice, with repeat lipids after
3 months
Lifestyle adviceAim: TC<5 mmol/L (190 mg/dL)LDL-C <3.0 mmol/L (115 mg/dL) Follow-up at 5-year intervals
TC <5 mmol/L (190 mg/dL) and LDL-C <3.0 mmol/L (115 mg/dL)
Maintain lifestyle advice with annual follow-up. If total risk remains 5%,
consider drugs to lower TC to <4.5 mmol/L(175 mg/dL) and LDL-C to <2.5 mmol/L (100 mg/dL)
TC 5 mmol/L (190 mg/dL) or LDL-C 3 mmol/L (115 mg/dL)
Maintain lifestyle advice and start drug
therapy
De Backer G et al. Eur Heart J 2003;24:1601–1610.
2003 European Guidelines:Guide to lipid management in asymptomatic
subjects
3rd European Guidelines Goals - Risk factors:
Prophylactic drug therapy should be considered in particular groups. These parameters have been
summarized as a mnemonic for the practitioner as the "European heart health telephone number":
14090530 140 mm Hg SBP 90 mm Hg DBP 5 mmol/L (150 mg/dL) total cholesterol 3 mmol/L (115 mg/dL) LDL cholesterol 0 NO SMOKING
Risk estimation is based on age, sex, smoking habits, systolic blood pressure (SBP), and either total cholesterol or cholesterol/HDL ratio.[7] Using the SCORE model, risk charts can be provided for all European countries. Total risk can be calculated from SCORE chartsThe low-risk chart is for countries such as Belgium. France, Greece, Italy, Luxembourg, Portugal, Spain, and Switzerland. Relative risk is calculated by comparing an individual's risk category with that of a nonsmoking person of the same age and gender with blood pressure </= 140/90 mm Hg and total cholesterol < 5 mmol/L (< 190 mg/dL).
Risk estimation is based on age, sex, smoking habits, systolic blood pressure (SBP), and either total cholesterol or cholesterol/HDL ratio.[7] Using the SCORE model, risk charts can be provided for all European countries. Total risk can be calculated from SCORE charts.The high-risk chart is for use in all other European countries. Relative risk is calculated by comparing an individual's risk category with that of a nonsmoking person of the same age and gender with blood pressure </= 140/90 mm Hg and total cholesterol < 5 mmol/L (< 190 mg/dL).
II. Magyar Terápiás Konszenzus Ajánlása kardiovaszkuláris betegségek
megelőzéséről és preventív kezelésérőlHáziorvos Továbbképzô Szemle 2006; 11: 131–138
II. Magyar Terápiás Konszenzus Ajánlása kardiovaszkuláris betegségek
megelőzéséről és preventív kezelésérőlHáziorvos Továbbképzô Szemle 2006; 11: 131–138