Dyslipidemia Malaysian CPG 2011

8/17/2019 Dyslipidemia Malaysian CPG 2011

1/23

HYPERCHOLESTEROLEMIA

MANAGEMENTBASED ON MALAYSIAN CPG

MANAGEMENT OF DYSLIPIDEMIA 2011

4 TH EDITION


2/23


3/23


4/23

SECONDARY DYSLIPIDAEMIA

• METABOLIC/ENDOCRINE

• Hypothyroii!"

• Typ# 2 Di$%#t#! M#&&it'!

• M#t$%o&i( Sy)ro"#

• C'!hi)*+! Sy)ro"#

• RENAL

•

E) !t$*# r#)$& i!#$!#• N#phroti( !y)ro"#

• HEPATIC

• O%!tr'(ti,# &i,#r i!#$!#

• Pri"$ry %i&i$ry (irrho!i!

• DR-GS

• A&(oho&

• Thi$.i# i'r#ti(!

•

B#t$ %&o(#r!


5/23

FRAMINGHAM CARDIOASC-LAR RISSCORE


6/23

DYSLIPIDAEMIA RIS FACTORFOR CD

• E,$t# LDLC

• Lo3 HDLC

• E,$t# TG

• E,$t# )o)HDLC

• Ath#ro*#)i( Dy!&ipi$#"i$


7/23

MAOR RIS FACTORS FOR CD

Positive risk factors5 M$ 6 47 y#$r! o8 $*#5 F#"$ 6 77 y#$r! o8 $*# or pr#"$t'r# "#)op$'!# 3itho'thor"o)$& r#p&$(#"#)t th#r$py5 Hyp#rt#)!io)5 C'rr#)t (i*$r#tt# !"oi)*5 F$"i&y hi!tory o8 "yo($ri$& i)8$r(tio) or !'#) #$th prior to$*# 77 i) $ "$ p$r#)t or "$ 9r!t #*r## r#&$ti,# $) prior to$*# :7 i) $ 8#"$ p$r#)t or oth#r

8#"$ 9r!t #*r## r#&$ti,#5 HDLC ; 1


8/23

LDL LEEL AND DR-G THERAPY

Global Risk LDL levels toinitiate drugtherapy

Target LDL levels

0 1 ri! 8$(tor 6 4 ;4


9/23

CHOLESTEROL SYNTHESIS


10/23

LIPIDLOERING AGENTS


11/23

STATINS

Lipid Efects Side Efects Contraindications

Initial dosage

LDL 177HDL 717 TG ?0

• Myop$thy• I)(r#$!#

&i,#r

#).y"#!

A%!o&'t#• A(ti,# or

(hro)i( &i,#r

i!#$!#• Pr#*)$)(y

$) &$(t$tio)R#&$ti,#• Co)(o"it$)t

'!# o8 (#rt$i)

r'*! #*( (&o! ori)

Lo,$!t$ti)20"* ONSi",$!t$ti)

20"* ONAtor,$!t$ti)10"* ON

• i)hi%itor! o8 HMG CoA r#'(t$!# th# r$t# &i"iti)* #).y"# i)h#p$ti( (ho!t#ro& !y)th#!i!

• !'it$% 9r!t&i)# $*#)t! i) 8$"i&i$& hyp#r(ho!t#ro"i$ 8orpri"$ry pr#,#)tio) o8 CD !#(o)$ry pr#,#)tio) o8 CD $) CHD#'i,$)t!

• S#r'" &ipi! $) $&$)i)# $"i)otr$)!8#r$!# !ho'& %# "#$!'r# $t

: 3##! $8t#r !t$rti)* tr#$t"#)t $) th#r#$8t#r $! )#(#!!$ry#!p#(i$&&y 3h#) o!#! $r# i)(r#$!#


12/23

FIBRATES


Initial dosage

LDL 720HDL 10?7 TG 2070

Dy!p#p!i$G$&&!to)#!Myop$thy

A%!o&'t#• S#,#r#

h#p$ti(

i!#$!#• S#,#r# r#)$&

i!#$!#• Pr#*)$)(y

$) &$(t$tio)R#&$ti,#• Co)(o"it$)t

'!# o8 (#rt$i)

B#.$9%r$t#200"* ODF#)o9%r$t#

?00"* ODG#"9%ro.i&?00"* BDCipro9%r$t#100"* OD

• P#roJi!o"# Pro&i8#r$tor A(ti,$t# R#(#ptor KPPAR $*o)i!t3hi(h i) t'r) !ti"'&$t#! !y)th#!i! o8 8$tty $(i oJi$tio)

• p$rti('&$r&y '!#8'& i) i)i,i'$&! 3ith (o"%i)# K"iJ#y!&ipi$#"i$ $) hyp#rtri*&y(#ri$#"i$< A&t#r)$ti,# tr#$t"#)t i)i)i,i'$&! 3ith "i& to "o#r$t# hyp#r(ho!t#ro"i$ 3ho $r#!t$ti) i)tor$)t

•

S#r'" $&$)i)# $"i)otr$)!8#r$!# !ho'& %# "o)itor# 3h#)!t$rti)* th#r$py or 3h#) o!#! $r# i)(r#$!#<


13/23

RESINS


Initial dosage

LDL 17?0HDL ?7 TG /

• GIT i!tr#!!• Co)!tip$tio)• D#(r#$!#

$%!orptio) o8(#rt$i) r'*!#* PCMNSAID! TCA

A%!o&'t#• Dy!%#t$&ipop

rot#i)#"i$• TG = 4


14/23

NICOTINIC ACID


Initial dosage

LDL 727HDL 17?7 TG 2070

• F&'!hi)*• Hyp#r*&y(#"i

$• Hyp#r'ri(#"i

$ Kor *o't• -pp#rGIT• i!tr#!!• H#p$totoJi(it

y

A%!o&'t#• Chro)i( &i,#r

i!#$!#• S#,#r# Go'tR#&$ti,#• Di$%#t#!

Khi*h o!#!o)&y

• Hyp#r'ri(#"i

$• P# ti(-&(#r

Ni$(i) 170"*BD

• #(r#$!# "o%i&i.$tio) o8 8r## 8$tty $(i! 8ro" $ipo!# ti!!'#!• th# 9r!t to !ho3 "ort$&ity r#'(tio) i) i)i,i'$&! 3ith CHD


15/23

CHOLESTEROL ABSORPTIONINHIBITORS


Initial dosage

LDL 127HDL ?7 TG 14

• H#$$(h#• A%o"i)$&

p$i)• Di$rrh#$

E.#ti"i%# 10"*OD

• !#(ti,#&y %&o( i)t#!ti)$& $%!orptio) o8 %oth i#t$ry $) %i&i$ry(ho!t#ro&! $) oth#r phyto!t#ro&!

• $! to $ r#'(tio) i) h#p$ti( (ho!t#ro& #&i,#ry• '!'$&&y '!# i) (o"%i)$tio) 3ith !t$ti)! to 8'rth#r &o3#r LDL• "o)oth#r$py 8or pri"$ry hyp#r(ho!t#ro"i$ i) p$ti#)t! 3ho

($))ot tor$t# !t$ti) or 9%r$t#


16/23

LIPID LOERING DIET

• D#(r#$!# i#t$ry (ho!t#ro&

• R#'(# i)t$# o8 or*$) "#$t #* &i,#r h#$rt %r$i)! i)#y to8ort)i*ht&y

•

D#(r#$!# tot$& 8$t/oi&• Gri&&/!t#$"/%oi&/%$#/"i(ro3$,# to r#'(# '!# o8 oi&! $) 8$t!

• R#'(# '!# o8 !$t'r$t# 8$t

• E* %'tt#r 8'&& (r#$" "i& !$)t$)

• I)(r#$!# '!# o8 po&y')!$t'r$t# oi&!

• E* o&i,#/!')Qo3#r/(or"/p$&"/!oy%#$)/p#$)'t oi&!

• I)(r#$!# i)t$# o8 (o"pJ ($r%ohyr$t#! $) 9%#r

• E* ri(# %r#$ p$!t$ 8r'it! ,#*#t$%!

• Choo!# 8oo hi*h i) prot#i) $) &o3 i) !$t'r$t# 8$t

•E* 9!h to8' #** 3hit#! p#$! $) %#$)! h$&


17/23

ELEATED TG

• O)(# LDLC $(hi#,# )#Jt t$r*#t i! TG ;1


18/23

COMORBIDDIABETES MELLIT-S

• PRIMARY TARGET

• LDLC ;2


19/23

St$ti)! !ho'& %# i)iti$t# i) $&& i)i,i'$&! $%o,# th# $*# o840 y#$r! 3ith T2DM r#*$r!! o8 %$!#&i)# LDLC


20/23

COMORBIDCORONARY HEART DISEASE

• F$!ti)* &ipi pro9 3ithi) 24 ho'r! o8 ho!pit$&i.$tio)

• I)iti$t# !t$ti) r#*$r!! o8 %$!#&i)# LDLC $) i#t

"oi9($tio)! $) (o)ti)'# i)#9)it#&y

• R#t#!t &ipi! 2? "o)th! $8t#r th# !t$rt o8 !t$ti) th#r$py

• LDLC t$r*#t ;2


21/23

COMORBIDHYPERTENSION

• Hyp#rt#)!i,# i)i,i'$&! 3itho't #!t$%&i!h# CD %'t

3ith "o#r$t# to hi*h C ri! K=10 ri! o8 #,#)t! i) 10

y#$r! !ho'& %# (o)!i#r# 8or !t$ti) th#r$py

irr#!p#(ti,# o8 %$!#&i)# LDLC ,#&!

• E#(t! o8 $)tihyp#rt#)!i,# $*#)t! o) &ipi ,#&! K#* hi*h

o!# thi$.i# i)(r#$!# TC LDLC $) TG $r# "o#!t $)

!ho'& )ot $#(t !#(tio) o8 $)tihyp#rt#)!i,# $*#)t!


22/23


23/23

COMORBIDCD

• Dy!&ipi$#"i$ o(('r! i) $&& !t$*#! o8 CD o) i$&y!i! $8t#r r#)$&

tr$)!p&$)t$tio) $) i) i)i,i'$&! 3ith )#phroti( !y)ro"#

• Ri! o8 #$th 8ro" CD i! hi*h#r th$) ri! o8 r#'iri)* r#)$&

r#p&$(#"#)t th#r$py

• I)i,i'$&! 3ith CD $) tho!# o) i$&y!i! #,$t# TG &o3 HDLC

• I) )#phroti( !y)ro"# #,$t# TC $) LDLC

• I8 TG =7

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Dyslipidemia Malaysian CPG 2011