Hyperlipidemia

The treatment for angina pectoris is multifactorial. All modifiable risk factors need to be addressed, such as the cholesterol level, high blood pressure issues, obesity, and smoking—all of which will worsen the progression of the disease. Antiplatelet drugs should be given on a regular basis, such as aspirin, ticagrelor, prasugrel, or clopidogrel. Symptom control should be used on an intermittent basis, such as nitroglycerin or calcium channel blockers. Things that will help lessen disease progression are ACE inhibitors for blood pressure and statin drugs for hyperlipidemia. The severely affected patient might need revascularization if medical therapy fails.

HYPERLIPIDEMIA

Hyperlipidemia is a major cause of cardiovascular disease, which is why all heart patients are good candidates for treatment of dyslipidemia. Remember that dyslipidemia can be related to an elevated total or LDL cholesterol, an elevated triglyceride level, or a low HDL level. Any of these will lead to atherosclerosis, which is the most common cause of the different types of heart disease. People can have primary or secondary dyslipidemia, with primary dyslipidemia being genetic in nature.

Labs will have a breakdown of what constitutes and elevated lipid situation but, in reality, there is no real cutoff involved where the risk for heart disease does not exist. People with other risk factors require much lower levels of cholesterol compared to those who have no other risk factors. Dyslipidemias are classified by an increase in cholesterol only, an increase in triglycerides only, or increases in both cholesterol and triglyceride levels. This doesn’t take into account that their might be a low HDL situation as well.

Most primary dyslipidemias are either single gene or multiple gene mutations affecting the production or clearance of cholesterol or triglycerides. These tend to run in families. In some cases, being a heterozygote for a single-gene disorder leads to a moderate increase in heart disease risk but being a homozygote is associated with a high risk of early heart disease.

Among secondary causes of dyslipidemia, one of the more common ones is living a sedentary lifestyle with a high calorie, high-fat diet. Other causes include chronic kidney

disease, diabetes mellitus, hypothyroidism, primary biliary cirrhosis, cigarette smoking, HIV disease, and certain drugs that affect cholesterol.

Diabetes is one of the highest risk disorders contributing to dyslipidemia. This is because they have naturally high triglyceride levels, abnormally small LDL particles, and low HDL levels. Type 2 diabetics are higher risk than type 1 diabetics. The added issues of obesity, physical inactivity, and high caloric intake make it more likely that dyslipidemia will be present.

While dyslipidemia has not typical symptoms, having the condition means having high levels of coronary artery disease, stroke, and peripheral vascular disease. If the triglyceride level is markedly high, acute pancreatitis can occur. There will be skin changes, such as tendinous xanthomas of the Achilles tendons or over the extensor joint surfaces, eruptive xanthomas on many body areas, arcus corneae of the eyes, and xanthelasma of the eyelids. Figure 7 shows what xanthelasmas look like:

Figure 7.