Hyperlipidemia

📚Definitions 

• Hyperlipidemia: Elevated serum LDL-C (≥130 mg/dL) or triglycerides (TG ≥150 mg/dL).

   

• Metabolic Syndrome: Presence of ≥3 of:

   

  • Abdominal obesity (waist >40" men, >35" women)
  • TG ≥150 mg/dL
  • HDL <40 mg/dL (men) or <50 mg/dL (women)
  • BP ≥130/85 mmHg or Dx tx
  • Fasting glucose ≥100 mg/dL or Dx T

🔑 Key Points (2025)

• Primary prevention: Statins reduce CVD risk by ~30% in eligible patients.
• Risk stratification: Use ACC/AHA Pooled Cohort Equations for 10-year CVD risk.

• Lifestyle modification: Foundation of management for all patients.

   

✏️ Assessment  

History

• Cardiovascular risk factors: Hypertension, diabetes, smoking, family history of premature ASCVD.
• Lifestyle: Diet, exercise, alcohol, tobacco/vaping use.
• Symptoms: Chest pain, dyspnea, claudication (screen for ASCVD).

Examination (Telehealth Adaptations)

• Vitals: BP, BMI (calculate annually).
• Cardiovascular: Heart rate, rhythm regularity (patient-reported).
• Abdomen: Central obesity (patient-measured waist circumference if feasible).

🚨 Risk Stratification

10-Year CVD Risk Calculation

*CAC = Coronary Artery Calcium score (if uncertainty exists).

LDL-C Thresholds

• ≥190 mg/dL: High-intensity statin (e.g., atorvastatin 40–80 mg).
• 70–189 mg/dL: Treat based on risk score.

💆 Treatment 

Lifestyle Modification

• Diet: Mediterranean or DASH diet; limit saturated fats (<7% calories), trans fats.
• Exercise: ≥150 min/week moderate activity.
• Weight loss: Target 5–10% reduction if overweight.

Pharmacotherapy

First-Line: Statins

Second-Line (if Statin-Intolerant or TG ≥500 mg/dL)

• Ezetimibe: Reduces LDL by ~18%.

• PCSK9 Inhibitors: For familial hypercholesterolemia or ASCVD.

• Fibrates (TG ≥500 mg/dL): Fenofibrate, gemfibrozil.

🔎 Monitoring

• Repeat lipids: 4–12 weeks after statin initiation, then annually.
• Liver enzymes: Baseline and PRN (statins).
• HbA1c: Annually if metabolic syndrome/diabetes.

📩 Referral Indicators 

• Urgent: Chest pain, acute dyspnea (ER referral).
• Non-urgent:
  • Refractory hyperlipidemia (endocrinology/cardiology).
  • CAC score evaluation (if risk uncertain).

📘 Coding

ICD-10 Codes: 

• E78.5: Hyperlipidemia, unspecified
• E78.2: Mixed hyperlipidemia

If you have any questions or would like more information, please reach out to the Delegating Physician.