Dyslipidemia Concept Map | Pathophysiology | Etiology | Treatment | Cholesterol Lowering Drugs

Dyslipidemia Concept Map
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Dyslipidemia (Hyperlipidemia) Concept Map: An Overview

The aim of this map is to cover the pharmacotherapy of dyslipidemia in an easy and an interesting way that will help you understand the topic and link it with the other related cardiovascular diseases as atherosclerosis.  Look inside the map and understand it through this video. 


EXPLANATION VIDEO

DEFINITION

The concept map of Dyslipidemia (Hyperlipidemia) starts with the definition.  Dyslipidemia is a disorder of elevated or abnormal levels of lipids and/or lipoproteins in the blood, characterized by high cholesterol, triglycerides (TGs), or both, or low High-density lipoprotein (HDL) level. 
From this definition branches out the normal physiology of lipid metabolism including what is meant by lipoproteins, function of lipoproteins, and their classification. Low-density lipoproteins (LDL); carry cholesterol from the liver to cells of the body; it is referred to as the "bad cholesterol" lipoprotein.  LDL has a role in initiating the atherosclerosis process; this is how dyslipidemia is a risk factor for atherosclerosis and consequently cardiovascular diseases (a small map for cardiovascular diseases categories is included).

LIPID METABOLISM (Normal Physiology)

In this map lipid metabolism is explained briefly through the following diagram:
Lipid Metabolism - Normal Physiology - Zoom out - Pharmacotherapy
Lipid Metabolism - Normal Physiology
Click to enlarge
The intestine absorbs dietary fat and packages it into chylomicrons, which are transported to peripheral tissues through the blood.  The enzyme lipoprotein lipase breaks down chylomicrons; and fatty acids enter muscle and adipose tissues. The chylomicron remnants are subsequently taken up by the liver to start the process of very-low-density lipoproteins (VLDLs) synthesis.  The liver secretes VLDL, which undergo lipolysis by lipoprotein lipase to form LDLs.  LDLs are then taken up by the liver and by the peripheral tissues.  HDL is produced by the liver.  Its function is to transport cholesterol from the body back to the liver.  That is why it is called “good cholesterol” lipoprotien.

CLINICAL PRESENTATION

Most patients are asymptomatic for many years prior to the appearance of physical findings. 
Physical findings can include:
  • corneal arcus of the eye and
  • tuberous xanthomas in the Achilles tendon, hands, feet, elbows, and/or knees.
And symptoms of dyslipidemia can include: paresthesias, dypsnea, and confusion.

CLASSIFICATION

Primary Dyslipidemia; occurs due to genetic mutations; it affects lipoprotein synthesis and metabolism causing the following lipid disorders:
        Isolated hypercholesterolemia (increase in cholesterol only)
-       Familial hypercholesterolemia (FH)
-       Familial defective apoB-100 (FDB)
-       Polygenic hypercholesterolemia
         Isolated hypertriglyceridemia (increase in TGs only)
-       Familial hypertriglyceridemia (FHTG)
-       Lipoprotein lipase (LPL) deficiency
-       Familial apoC-II deficiency
         Mixed or combined hyperlipidemias (increase in both cholesterol and TGs)
-       Familial combined hyperlipidemia (FCHL)
-       Familial dysbetalipoproteinemia (FDBL)
Watch the video to know when Primary Dyslipidemia is suspected in a patient.
On the other hand, Secondary Dyslipidemia can be caused by the following:
- Diseases: diabetes, hypothyrodism, obstructive liver disease/ biliary cirrhosis, renal disease, nephrotic syndrome/ chronic renal failure, or obesity.
- Drugs: estrogen, progestins, protease inhibitors, anabolic steroids, corticosteroids, isotretinoin, cyclosporine, atypical antipsychotics, thiazide diuretics, or β-Blockers.
These causes should be considered in the diagnosis and the management of dyslipidemia.

RISK FACTORS

Dyslipidemia risk factors are classified as:
  • Positive Risk Factors
  • Negative Risk Factors
  • Emerging Risk Factors
Details are available in the video above.

DIAGNOSIS

Diagnosis of dyslipidemia is based on the Fasting Lipid Profile of the patient; accompanied by the assessment of cardiovascular risk factors using Framingham Risk Score for patients with ≥2 risk factors.
Three Categories of Risk that Modify LDL-Cholesterol Goals (details are included in the map/video):
1-      CHD and CHD Risk Equivalents.
2-      For patients with ≥2 risk factors, perform Framingham 10-year CHD risk assessment.
3-      For patients with ≤1 risk factor, 10-year risk assessment is not required.
These risk categories are linked to (treatment goals) part in the map.

TREATMENT

This part of the map starts with dyslipidemia treatment goals (classified according to the risk category) and targets (primary target for therapy is LDL).
Therapeutic Lifestyle Changes (TLC) and dietary recommendations are stated under the part of non-pharmacological treatment of dyslipidemia.

Pharmacological treatment of dyslipidemia includes:

Four classes of lipid-lowering drugs:

  •     the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (the "statins"), including; atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, and pitavastatin
  •          the fibrates (gemfibrozil and fenofibrate),
  • niacin/nicotinic acid, and
  • the bile acid binding resins (colestipol, colesevelam, and cholestyramine)
In addition to; 
  •  the cholesterol absorption inhibitor, Ezetimibe, and
  •        Omega-3 fatty acids (fish oils)
Each drug / drug class has its own map that covers: the mechanism of action, indications, adverse effects, drug interactions, contraindications, and precautions if any.  The map also shows you how to manage certain adverse effects and drug interactions for these drugs.  See the following example for Bile acid sequestrants.
Bile Acid Sequestrants Map
Bile Acid Sequestrants
Click to enlarge

Dyslipidemia (Hyperlipidemia) Concept Map Folded Poster
Dyslipidemia Folded Poster

We hope you find Dyslipidemia Concept Map helpful and we are looking forward to hearing your opinionThis map is available in the following formats: 









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The maps is printed out on ordinary A1 size paper and it is folded to be nearly sized as A4 paper.

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Other countries: 2-3 weeks; you can upgrade to express mail. Please contact us for details.

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The map is split into pages to be printed on nine A4 papers. After printing them, you have to tape the edges together to make a folded poster.

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A .pdf file for the printable version of the map will be available for download immediately after payment received.

Printing is allowed. The map is to be printed out on several pages.
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Dyslipidemia concept map is written by: May Mehanna, BCPS
Reviewed and edited by Maha Atef, B Pharm.
Last updated on: 11 January 2013 
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We are a team of pharmacists who are interested in the science of pharmacotherapy, which is represented through this site. At this site we are trying to help whoever experiences difficulty understanding and memorizing diseases and their corresponding treatment approaches. We are convinced with the idea of connecting information together and making links between it, to prevent its escape from minds, so we are presenting diseases using the concept mapping and the mind mapping methods to help in dealing with “information explosion!” in the field of pharmacotherapy. We really hope that you find this site helpful. Know more about those who are Zooming out!