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![Assessment for disorders of Lipid Metabolism
Friedewald Formula
• LDL-C = TC – (TG/5 + HDL-C) [mg/dL]
• Requirements
• Triglyceride to Cholesterol ratio in Very Low Density Lipoprotein (VLDL) is relatively
constant in normal subjects and nearly all patients with dyslipidemia at about 5:1
• When chylomicrons are not detectable in the blood, most of the triglyceride in
plasma is from VLDL (Fasting – 12 hours)
• Not accurate when TG is greater than 400mg/dL
• Not reliable when LDL-C is less than 70mg/dL](https://image.slidesharecdn.com/1lipidsandlipoproteins20241-251123101304-05e5dbc3/75/1-Lipids-and-Lipoproteins-2024gb-1-pdf-15-2048.jpg)
![Assessment for disorders of Lipid Metabolism
Plasma Apolipoprotein B
• present on atherogenic lipoproteins and serves as a macromolecular scaffold to
provide structural integrity. I
• t also serves as a ligand for the LDL receptor, which facilitates its clearance from the
plasma.
• There are two major isoforms of apoB: apoB48, found on intestinally derived
lipoproteins (chylomicrons and their remnants) and apoB100, found on hepatically
derived lipoproteins – very LDL, intermediate-density lipoprotein, LDL and lipoprotein
(a) (Lp[a]).
.](https://image.slidesharecdn.com/1lipidsandlipoproteins20241-251123101304-05e5dbc3/75/1-Lipids-and-Lipoproteins-2024gb-1-pdf-18-2048.jpg)
![Lipoprotein metabolism and CAD[1].pptx..](https://cdn.slidesharecdn.com/ss_thumbnails/lipoproteinmetabolismandcad1-250223181828-e4e0a658-thumbnail.jpg?width=640&height=640&fit=bounds)
1 Lipids and Lipoproteins 2024gb (1).pdf
- 1. LIPIDS AND LIPOPROTEINS KUTIMA FWACP(LAB MED)
- 2. Importance of Lipidsand Lipoproteins Physiologic: • Cholesterol & phospholipids are vital structural components of cellular membranes. • Cholesterol is the precursor of steroid hormones and bile acids • Triglyceride is an important storage and transport form of energy • Absorption of dietary lipid is essential for the absorption of fat-soluble vitamins
- 3. Importance of Lipidsand Lipoproteins Pathologic • Hypercholesterolaemia (and to a lesser extent hypertriglyceridaemia) is associated with an increased risk of developing atherosclerosis. • Hypertriglyceridaemia predisposes patients to pancreatitis • Rare inherited defects of lipid metabolism occur, causing significant morbidity and mortality.
- 4. The Major Lipidsin Plasma Sterol lipids (22%) - Cholesterol and Cholesterol Ester • can be synthesized de novo from acetyl Co-A in the liver. • The rate-limiting step is catalysed by HMG-CoA reductase . • Also derived from ‘animals’ in diet. Cf Plants Sterols Glycerol Lipids (14%) - Triglycerides • Endogenous source - liver which utilises fatty acids • Exogenous source derived from dietary fatty acids
- 5. The Major Lipidsin Plasma Sphingolipids (35%) Sphingomyelin Glycerolphospholipids (29%) Phosphatidylcholine, Phosphatidylethanolamine Fatty Acyls (<1%) Fatty Acids All of these lipids can be measured in plasma…depending on the clinical indication
- 6. Lipid Transport inthe Plasma Lipids are relatively insoluble in water They are transported in the aqueous environment of the plasma as lipoproteins. Lipoproteins Macromolecular complexes that are soluble in plasma and contain an internal core of lipids. They consists of esterified and unesterified cholesterol, triglycerides, phospholipids and apolipoproteins. Apolipoprotein The protein constituent of lipoproteins. Apolipoproteins play a role in assembly and secretion of lipoproteins, provide structural integrity, activate or inhibit enzymes and act as ligands for specific receptors, mitigating uptake of particles or lipid components.
- 8. Lipoprotein Metabolic Pathways •Exogenous cholesterol transport for delivery of dietary lipids to the tissues • Permits efficient transport of dietary lipids…energy to the tissues without going thro the liver. • Endogenous cholesterol transport for delivery of hepatic lipids to the tissues • Permits the delivery of cholesterol to the tissues….more efficient for tissues to receive cholesterol than to make cholesterol • Reverse cholesterol transport • Cholesterol in peripheral cells is transported from the plasma membranes of peripheral cells to the liver and intestine
- 9. Metabolic PathwayLipoprotein SourceLipids TG; CL Notable Apoproteins Exogenous Chylomicrons (CL) Dietary 90; 4 Apo B-48, Apo E Exogenous CL Remnants Circulation Apo B-48, Apo E Endogenous VLDL Liver 75; 15 Apo B-100, Apo E, Endogenous IDL Circulation 30; 30 Apo B-100, Apo E, Endogenous LDL Circulation 5; 50 Apo B-100 Reverse Cholesterol HDL Liver, GIT 5; 20 Apo A-I, Apo A-II, Lp (a) Apo B-100, Apo (a) Overview Of Lipoproteins
- 10. Atherosclerotic Cardiovascular Disease Atherosclerosisrefers to the underlying disorder involving the intima of medium size and large arteries, which leads to the accumulation of lipid, mainly cholesterol and cholesterol laden macrophages (foam cells), and the development of a raised fibrous lesion. Atherosclerosis of the • coronary arteries auses myocardial infarction & angina pectoris • arteries supplying the central nervous system provokes strokes and TIA • peripheral circulation causes intermittent claudication and gangrene • splanchnic circulation can cause mesenteric ischemia. • Kidneys can cause renal artery stenosis
- 11. Lipids and AtheroscleroticCardiovascular Disease • Retention of apoB-containing lipoproteins in the subendothelial space is an initial step • Modification (oxidation, glycation), of retained lipoproteins drives activation of endothelial cells. • Activated cells increase expression of monocyte interaction/adhesion molecules & chemoattractants with attachment/transmigration of monocytes into the intimal space. • Monocytes differentiate into macrophages and express receptors that mediate the internalization of VLDL, APOE remnants, and modified LDL to become foam cells. • In addition, inflammatory signaling pathways are activated in macrophage foam cells leading to more cell recruitment and LDL modification.
- 12. Atherogenic and Anti-AtherogenicLipoproteins Atherogenic lipoproteins – lipoproteins which increase the risk of the development of atherosclerosis - ApoB containing – VLDL, IDL, LDL, Lipoprotein (a) Anti-atherogenic lipoproteins - lipoproteins which decrease the risk of the development of atherosclerosis - HDL
- 13. Assessment for riskof ASCVD Lipid Profile Standard panel • Total Cholesterol – all the cholesterol in all the lipoproteins in plasma • Triglycerides – all the triglycerides in all the lipoproteins in plasma • HDL-cholesterol – the cholesterol in high density lipoprotein in plasma surrogate of HDL • LDL- cholesterol – the cholesterol in low density lipoprotein in plasma surrogate of LDL
- 14. Assessment for disordersof Lipid Metabolism LDL-cholesterol • Primary cause of atherosclerosis • Used to define statin benefit group • Used to define treatment targets • Unlike the other parameters, it is not easily and accurately measured directly • Usually determined by calculation from the concentration of TC, HDL-C and TG determined from fasting samples • Friedewald formula • Martins-Hopkins Equation • Sampson NIH equation
- 15. Assessment for disordersof Lipid Metabolism Friedewald Formula • LDL-C = TC – (TG/5 + HDL-C) [mg/dL] • Requirements • Triglyceride to Cholesterol ratio in Very Low Density Lipoprotein (VLDL) is relatively constant in normal subjects and nearly all patients with dyslipidemia at about 5:1 • When chylomicrons are not detectable in the blood, most of the triglyceride in plasma is from VLDL (Fasting – 12 hours) • Not accurate when TG is greater than 400mg/dL • Not reliable when LDL-C is less than 70mg/dL
- 16. Assessment for disordersof Lipid Metabolism • Extended Martins-Hopkins Equation • Sampson NIH equation • Applicable up to TG < 800mg/dL • Calculation requires Apps or online calculators • There are other equations…
- 17. Assessment for disordersof Lipid Metabolism Non-high-density Lipoprotein Cholesterol (Non-HDL-C) • represents the cholesterol contained in all lipoproteins except HDL-C and it can be calculated from the standard lipid panel by subtracting HDL-C from total cholesterol. • It represents the cholesterol content present in all atherogenic lipoproteins and serves as a better surrogate for the overall atherogenic burden than LDL-C alone, making it a useful marker in the assessment of CVD risk. • May also be used as a target of therapy
- 18. Assessment for disordersof Lipid Metabolism Plasma Apolipoprotein B • present on atherogenic lipoproteins and serves as a macromolecular scaffold to provide structural integrity. I • t also serves as a ligand for the LDL receptor, which facilitates its clearance from the plasma. • There are two major isoforms of apoB: apoB48, found on intestinally derived lipoproteins (chylomicrons and their remnants) and apoB100, found on hepatically derived lipoproteins – very LDL, intermediate-density lipoprotein, LDL and lipoprotein (a) (Lp[a]). .
- 19. Assessment for disordersof Lipid Metabolism Plasma Apolipoprotein B • Each of these atherogenic particles harbours single copy of apoB. • Thus, apoB represents a better proxy of total atherogenic lipoprotein particle concentration • Target of therapy and risk assessment .
- 20. Assessment for disordersof Lipid Metabolism Small dense LDL-cholesterol • LDL consists of several subclasses of particles with different sizes and densities, including large buoyant (lb) and intermediate and small dense (sd) LDLs. • sdLDL has a greater atherogenic potential than that of other LDL subfractions and is a better marker for prediction of cardiovascular disease than that of total LDL-C. • Circulating sdLDL readily undergoes multiple atherogenic modifications in blood plasma, such as desialylation, glycation, and oxidation, that further increase its atherogenicity.
- 21. Assessment for disordersof Lipid Metabolism Low-density Lipoprotein Particle Number • LDL particle (LDL-P) number represents an alternative to LDL-C as a marker of CVD risk. • LDL-P represents the concentration in nanomoles of LDL particles per litre of plasma volume, LDL-C represents the cholesterol mass in milligrams found in LDL particles in a decilitre of plasma. .
- 22. Assessment for disordersof Lipid Metabolism Lipoprotein(a) • Lp(a) consists of a molecule of apolipoprotein(a) – apo(a) – a non- functional mimic of plasminogen, covalently bound to apoB on an LDL-like particle. • Significant heterogeneity between apo(a) isoforms confers heterogeneity in Lp(a) particles. • Plasma concentration of Lp(a) is >90% genetically determined in an autosomal co- dominant fashion, with adult levels achieved by about 5 years of age. • Lp(a) levels remain stable throughout life regardless of lifestyle.
- 23. Lipids and AtheroscleroticCardiovascular Disease • Lifestyle Risk Factors • Obesity (BMI ≥30 Kg/M2) • Physical Inactivity • Atherogenic Diet • Emerging Risk Factors • Lipoprotein (A) • Prothrombotic Factors • Proinflammatory Factors • Impaired Fasting Glucose • Subclinical Atherosclerosis • High LDL Cholesterol • Low HDL Cholesterol • <40 mg/dL • Cigarette Smoking • Hypertension • BP ≥140/90 mmHg or On AntiHTsive • Diabetes Mellitus • Family History Of Premature CHD • Age • Men ≥45yrs; Women ≥55yrs • Stage 3 or 4 chronic kidney disease Apart from disorders of cholesterol, other risk factors exist for the development of ASCVD
- 24. Lipids and AtheroscleroticCardiovascular Disease • At the very heart of primary prevention is the identification of individuals at-risk of atherosclerotic cardiovascular disease • This requires a consideration of all risk factors…NOT JUST plasma lipids. • CVD risk prediction equations allow for the combination of all the major risk factors 1) Report a single numerical risk estimate for the individual – 10 year risk 2) Next step is to categorise risk level • Numerical estimate and risk categorization varies with the equation used
- 25. CVD risk predictionequations • CVD risk equations (requires an APP or online calculator) • Predicting Risk of cardiovascular disease EVENTs (PREVENT) • Estimates the 10- and 30-year risk of heart attack and stroke for people aged 30 years and older • Pooled Cohort Equations • Estimate the 10-year primary risk of ASCVD among patients without pre-existing cardiovascular disease who are between 40 and 79 years of age. • Framingham Risk Score for Hard Coronary Heart Disease • for use in non-diabetic patients age 30-79 years with no prior history of coronary heart disease or intermittent claudication • Systematic Coronary Risk Evaluation 2 (SCORE2) • Predicts 10-year CVD risk in patients without prior CVD or diabetes
- 26. WHO cardiovascular diseaserisk laboratory-based charts Western Sub-Saharan Africa Benin, Burkina Faso, Cote d’Ivoire, Cameroon, Cabo Verde, Ghana, Guinea, Gambia, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Sao Tome and Principe, Chad, Togo Risk Level <5% 5% to <10% 10% to <20% 20% to <30% ≥30% Risk Level <5% 5% to <10% 10% to <20% 20% to <30% ≥30% 70-74 70-74 22 24 26 29 32 18 20 22 24 27 15 16 18 20 22 12 13 15 16 18 10 11 12 13 15 28 30 33 36 40 23 25 28 31 34 19 21 23 25 28 15 17 19 21 23 13 14 15 17 19 18 19 20 21 22 15 16 17 17 18 13 13 14 15 15 11 11 12 12 13 9 9 10 10 11 25 27 28 29 30 22 22 23 25 26 18 19 20 21 22 15 16 17 17 18 13 13 14 15 15 SBP (mmHg) ≥180 160-179 140-159 120-139 <120 30 32 36 39 43 25 27 30 33 36 20 22 25 27 31 17 18 20 23 25 14 15 17 19 21 37 41 44 48 53 31 34 38 41 45 26 28 31 35 39 21 24 26 29 32 17 19 22 24 27 27 28 30 31 33 23 24 25 26 28 19 20 21 22 24 16 17 18 19 20 14 14 15 16 17 37 39 41 42 44 32 33 35 37 38 27 29 30 31 33 23 24 25 27 28 19 20 21 23 24 SBP (mmHg) ≥180 160-179 140-159 120-139 <120 65-69 65-69 17 19 21 23 26 14 15 17 19 21 11 12 13 15 17 9 10 11 12 14 7 8 9 10 11 23 25 28 31 35 18 21 23 26 29 15 17 18 21 23 12 13 15 17 19 9 11 12 13 15 14 15 15 16 17 11 12 13 13 14 9 10 10 11 12 8 8 8 9 10 6 6 7 7 8 21 22 23 25 26 17 18 19 21 22 14 15 16 17 18 12 12 13 14 15 10 10 11 12 12 ≥180 160-179 140-159 120-139 <120 25 27 30 34 37 20 22 25 28 31 16 18 20 22 25 13 14 16 18 21 10 11 13 15 17 33 36 40 44 49 27 30 33 37 41 22 24 27 31 34 18 20 22 25 28 14 16 18 20 23 22 24 25 26 28 18 19 21 22 23 15 16 17 18 19 12 13 14 15 16 10 11 12 12 13 33 35 37 39 41 28 29 31 33 35 23 25 26 28 30 19 20 22 23 25 16 17 18 19 21 ≥180 160-179 140-159 120-139 <120 60-64 60-64 13 15 16 18 21 10 11 13 14 16 8 9 10 11 13 6 7 8 9 10 5 5 6 7 8 19 21 24 27 30 15 17 19 21 24 12 13 15 17 19 9 10 12 13 15 7 8 9 10 12 10 11 12 13 14 8 9 9 10 11 7 7 8 8 9 5 6 6 7 7 4 5 5 5 6 17 18 20 21 23 14 15 16 17 19 11 12 13 14 15 9 10 10 11 12 7 8 8 9 10 ≥180 160-179 140-159 120-139 <120 20 23 25 29 32 16 18 20 23 26 13 14 16 18 21 10 11 13 14 17 8 9 10 11 13 29 32 36 40 45 23 26 29 33 37 18 21 23 27 31 14 16 19 21 25 11 13 15 17 20 18 19 21 22 24 15 16 17 18 19 12 13 14 15 16 9 10 11 12 13 8 8 9 9 10 30 32 34 36 39 24 26 28 30 32 20 21 23 25 27 16 17 19 20 22 13 14 15 16 18 ≥180 160-179 140-159 120-139 <120 55-59 55-59 10 11 13 14 17 8 9 10 11 13 6 7 7 9 10 4 5 6 7 8 3 4 4 5 6 16 17 20 23 26 12 13 15 18 20 9 10 12 14 16 7 8 9 11 12 5 6 7 8 10 8 8 9 10 11 6 7 7 8 8 5 5 6 6 7 4 4 4 5 5 3 3 3 4 4 14 15 17 18 20 11 12 13 14 16 9 10 10 11 12 7 8 8 9 10 5 6 6 7 8 ≥180 160-179 140-159 120-139 <120 17 19 21 24 28 13 15 16 19 22 10 11 13 15 17 7 9 10 11 13 6 6 7 9 10 26 29 32 37 42 20 23 26 29 34 15 18 20 23 27 12 14 16 18 21 9 10 12 14 17 15 16 17 19 20 12 13 14 15 16 9 10 11 12 13 7 8 8 9 10 6 6 7 7 8 26 28 31 33 36 21 23 25 27 29 17 18 20 22 24 13 14 16 17 19 10 11 13 14 15 ≥180 160-179 140-159 120-139 <120 50-54 50-54 8 9 10 11 13 6 6 7 8 10 4 5 5 6 7 3 4 4 5 6 2 3 3 4 4 13 14 17 19 22 10 11 13 15 17 7 8 9 11 13 5 6 7 8 10 4 5 5 6 8 6 6 7 8 8 5 5 5 6 6 3 4 4 4 5 3 3 3 3 4 2 2 2 3 3 12 13 14 15 17 9 10 11 12 13 7 8 8 9 10 5 6 6 7 8 4 4 5 5 6 ≥180 160-179 140-159 120-139 <120 14 16 18 20 24 10 12 13 16 18 8 9 10 12 14 6 7 8 9 11 4 5 6 7 8 23 25 29 33 39 17 20 23 26 31 13 15 17 20 24 10 11 13 16 18 7 8 10 12 14 12 13 14 16 17 9 10 11 12 13 7 8 8 9 10 5 6 7 7 8 4 5 5 6 6 23 25 28 30 33 18 20 22 24 27 14 16 17 19 21 11 12 13 15 17 8 9 10 12 13 ≥180 160-179 140-159 120-139 <120 45-49 45-49 6 7 8 9 10 4 5 6 6 8 3 3 4 5 6 2 3 3 3 4 2 2 2 3 3 10 12 14 16 19 8 9 10 12 14 6 6 7 9 11 4 5 6 7 8 3 3 4 5 6 5 5 5 6 7 3 4 4 4 5 2 3 3 3 4 2 2 2 2 3 1 1 2 2 2 10 11 12 13 14 7 8 9 10 11 5 6 7 7 8 4 4 5 6 6 3 3 4 4 5 ≥180 160-179 140-159 120-139 <120 12 13 15 17 20 8 10 11 13 15 6 7 8 9 11 4 5 6 7 8 3 4 4 5 6 20 23 26 30 35 15 17 20 23 27 11 13 15 18 21 8 9 11 13 16 6 7 8 10 12 10 11 12 13 14 7 8 9 10 11 5 6 7 7 8 4 4 5 6 6 3 3 4 4 5 20 23 25 28 31 16 17 19 22 24 12 13 15 17 19 9 10 11 13 15 7 8 9 10 11 ≥180 160-179 140-159 120-139 <120 40-44 40-44 5 5 6 7 8 3 4 4 5 6 2 3 3 4 4 2 2 2 3 3 1 1 2 2 2 9 10 11 14 16 6 7 8 10 12 4 5 6 7 9 3 4 4 5 6 2 3 3 4 5 3 4 4 5 5 2 3 3 3 4 2 2 2 2 3 1 1 2 2 2 1 1 1 1 1 8 9 10 11 12 6 6 7 8 9 4 5 5 6 7 3 3 4 4 5 2 3 3 3 4 ≥180 160-179 140-159 120-139 <120 10 11 12 14 17 7 8 9 10 13 5 5 6 8 9 3 4 5 5 7 2 3 3 4 5 18 20 23 27 32 13 15 17 20 25 9 11 13 15 18 7 8 9 11 14 5 6 7 8 10 8 9 10 11 12 6 6 7 8 9 4 5 5 6 7 3 3 4 4 5 2 2 3 3 4 18 20 22 25 28 13 15 17 19 22 10 11 13 15 17 7 8 10 11 13 6 6 7 8 10 ≥180 160-179 140-159 120-139 <120 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 <4 4-4.9 5-5.9 6-6.9 ≥ 7 People with Diabetes People without Diabetes Total cholesterol (mmol/l) Total cholesterol (mmol/l) Age Men Women (years) Non-smoker Smoker Non-smoker Smoker Age Men Women (years) Non-smoker Smoker Non-smoker Smoker Western Sub-Saharan Africa
- 27. Western Sub-Saharan Africa 70-74 2324 26 28 30 19 20 21 23 25 15 16 17 19 20 12 13 14 15 16 10 11 11 12 13 29 31 33 36 38 24 26 28 30 32 20 21 23 24 26 16 17 18 20 21 13 14 15 16 17 20 21 21 22 23 17 17 18 18 19 14 14 15 15 16 11 12 12 13 13 9 10 10 10 11 29 30 31 32 33 24 25 26 27 28 20 21 21 22 23 17 17 18 18 19 14 14 15 15 16 SBP (mmHg) ≥180 160-179 140-159 120-139 <120 65-69 17 19 21 22 24 14 15 16 18 20 11 12 13 14 16 9 9 10 11 12 7 7 8 9 10 24 26 29 31 34 19 21 23 25 27 15 17 18 20 22 12 13 15 16 18 10 11 12 13 14 15 16 17 17 18 12 13 13 14 15 10 10 11 11 12 8 8 9 9 9 6 7 7 7 8 24 25 26 27 29 20 21 21 22 23 16 17 17 18 19 13 13 14 15 15 10 11 11 12 12 ≥180 160-179 140-159 120-139 <120 60-64 13 15 16 18 20 10 11 13 14 16 8 9 10 11 12 6 7 7 8 9 5 5 6 6 7 20 22 24 27 30 16 17 19 21 24 12 13 15 17 19 9 10 12 13 15 7 8 9 10 11 12 12 13 14 14 9 10 10 11 11 7 8 8 8 9 6 6 6 6 7 4 5 5 5 5 20 21 22 24 25 16 17 18 19 20 13 13 14 15 16 10 11 11 12 12 8 8 9 9 10 ≥180 160-179 140-159 120-139 <120 55-59 10 11 13 14 16 8 9 10 11 12 6 6 7 8 9 4 5 5 6 7 3 4 4 5 5 16 18 21 23 26 12 14 16 18 20 9 11 12 14 16 7 8 9 10 12 5 6 7 8 9 9 10 10 11 11 7 7 8 8 8 5 5 6 6 6 4 4 4 5 5 3 3 3 3 4 17 18 19 20 21 13 14 15 16 16 10 11 11 12 13 8 8 9 9 10 6 6 7 7 7 ≥180 160-179 140-159 120-139 <120 50-54 8 9 10 11 13 6 6 7 8 10 4 5 5 6 7 3 3 4 5 5 2 2 3 3 4 13 15 18 20 23 10 11 13 15 18 7 8 10 11 13 5 6 7 8 10 4 5 5 6 7 7 7 8 8 9 5 5 6 6 6 4 4 4 4 5 3 3 3 3 3 2 2 2 2 3 14 15 16 17 18 11 11 12 13 14 8 9 9 10 10 6 6 7 7 8 4 5 5 5 6 ≥180 160-179 140-159 120-139 <120 45-49 6 7 8 9 11 4 5 6 7 8 3 3 4 5 5 2 2 3 3 4 1 2 2 2 3 11 13 15 17 20 8 9 11 13 15 6 7 8 9 11 4 5 6 7 8 3 3 4 5 6 5 6 6 6 7 4 4 4 5 5 3 3 3 3 3 2 2 2 2 2 1 1 2 2 2 12 13 14 15 16 9 9 10 11 11 6 7 7 8 8 5 5 5 6 6 3 4 4 4 4 ≥180 160-179 140-159 120-139 <120 40-44 5 5 6 7 9 3 4 4 5 6 2 3 3 4 4 1 2 2 2 3 1 1 1 2 2 9 11 13 15 18 6 7 9 11 13 4 5 6 8 9 3 4 4 5 6 2 3 3 4 5 4 4 5 5 5 3 3 3 3 4 2 2 2 2 3 1 1 2 2 2 1 1 1 1 1 10 11 12 12 13 7 8 8 9 10 5 5 6 6 7 4 4 4 4 5 2 3 3 3 3 ≥180 160-179 140-159 120-139 <120 <20 20-24 25-29 30-35 ≥ 35 <20 20-24 25-29 30-35 ≥ 35 <20 20-24 25-29 30-35 ≥ 35 <20 20-24 25-29 30-35 ≥ 35 Body mass index (kg/m^2) Age Men Women (years) Non-smoker Smoker Non-smoker Smoker WHO cardiovascular disease risk non laboratory based charts Western Sub-Saharan Africa Benin, Burkina Faso, Cote d’Ivoire, Cameroon, Cabo Verde, Ghana, Guinea, Gambia, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Sao Tome and Principe, Chad, Togo Risk Level <5% 5% to <10% 10% to <20% 20% to <30% ≥30% Non-laboratory based risk chart
- 28. CVD risk predictionequations - Pooled Cohort equation • Variables Results • Age (yrs) 10 year estimate • Race – American Indian, Asian, Black or African American, White • Sex – Male or Female • Total Cholesterol Risk Categorization • HDL-cholesterol low - <5% • Systolic blood pressure borderline 5 - <7.5% • On Hypertensive medication Y/N intermediate 7.5 - <20% • Diabetes Y/N high >20% • Smoker Y/N
- 29. CVD risk predictionequations – Framingham Risk Coronary Hard • Variables Results • Age (yrs) 10 year estimate • Sex – Male or Female Risk Categorization • Total Cholesterol low - <10% • HDL- Cholesterol intermediate >10 - <20% • Systolic blood pressure high >20% • On Hypertensive medication Y/N • Diabetes Y/N • Smoker Y/N
- 30. Primary Prevention ofASCVD - • American College of Cardiology/ American Heart Association Task Force (2013) • Primary Prevention: Assess ASCVD risk and emphasize adherence to healthy lifestyle • Statin therapy • LDL-C ≥190 mg/dL without secondary cause (e.g., saturated/trans fats, drugs, certain diseases) • Primary prevention with diabetes mellitus: age 40–75 years, LDL-C 70–189 mg/dL • Primary prevention without diabetes mellitus: age 40–75 years, LDL-C 70–189 mg/dL, estimated ASCVD risk ≥7.5%
- 31. Primary Prevention ofASCVD - • Canadian Cardiovascular Society • Primary Prevention: Assess ASCVD risk and emphasize adherence to healthy lifestyle • Statin therapy LDL-C apoB non-HDL-C • FRS score <5% >193 mg/dL >1.45 g/L 224mg/dL • FRS 5.0 - 9.9% > 135 mg/dL 1.05 g/L 193 mg/dL • FRS score 10 – 19.9% > 135 mg/dL 1.05 g/L 193 mg/dL • FRS score 20%
- 32. Primary Prevention ofASCVD - • European Society of Cardiology and European Atherosclerosis Society • Primary Prevention: Assess ASCVD risk and emphasize adherence to healthy lifestyle • Statin therapy LDL-C • SCORE <5% > 190mg/dL • >5 - <10% > 116 mg/dL • >10% > 70mg/dL
- 33. Assessment for disordersof Lipid Metabolism
- 34. Assessment for disordersof Lipid Metabolism Triglyceride Increased levels are indicative of a metabolic abnormality and, along with elevated cholesterol, are considered a risk factor for atherosclerotic disease. Hyperlipidemia may be inherited or be associated with biliary obstruction, diabetes mellitus, nephrotic syndrome, renal failure, or metabolic disorders related to endocrinopathies. Increased triglycerides may also be associated with alcohol consumption, sedentarism or medication-induced (eg, prednisone). Since cholesterol and triglycerides can vary independently, measurement of both is more meaningful than the measurement of cholesterol only.
- 35. Assessment for disordersof Lipid Metabolism Triglyceride > or =18 years: Normal: <150 mg/dL Borderline high: 150-199 mg/dL High: 200-499 mg/dL Very high: > or =500 mg/dL Very high levels are strongly associated with acute pancreatitis.