HYPOLIPIDEMIC AGENTS
ETIOLOGY
ATHEROSCLEROSIS
RISK FACTORS
RISK FACTORS
Male > 45 years old, female > 55 y/o
Family history of CHD (coronary heart disease)
Hypertension
Low HDL-C (<40 mg/dl)
Smoking
TREATMENT GOALS
Patient Category LDL Target (mg/dl)
No CHD, < 2 risk factors <160 mg/dl
No CHD, > 2 risk factors <130 mg/dl
CHD
<100 mg/dl
CONSEQUENCES
Increased atherosclerosis
Coronary Artery Disease
Hypertension
Stroke
Peripheral vascular disease
LIPOPROTEINS
Very Low Density Lipoproteins (VLDL)
Associated with triglycerides
Decreases with lowering saturated fats in diet
Low Density Lipoproteins (LDL)
Associated with cholesterol
Does not decrease with lowering cholesterol
High Density Lipoprotein (HDL)
Increases with exercise - protectant
DRUG THERAPY
INCREASE
ELIMINATION
Colestipol
Cholestyramine
DECREASE
PRODUCTION
Fenofibrate
Gemfibrozil
HMG CoA Reductase
(statins)
Nicotinic Acid
(Vitamin B3)
BILE SEQUESTERING AGENTS
Blocks enterohepatic recycling
Binds bile acids in GI tract, causing elimination
Interaction - Binds fat soluble medications and
vitamins, therefore administer at different times
HMG-CoA Reductase
Hydroxymethyl-glutaryl-CoA Reductase
Reduces conversion of HMG-CoA to mevalonic acid
(precursor to cholesterol)
Inhibits LDL production
Dramatic reduction
Monitor LFTs and retina
GEMFIBROZIL
Decreases triglyceride production
May increase HDL
May reverse plaque formation
Drug interaction with HMG-CoA Reductase
rhabdomyolysis
FENOFIBRATE
Decreases triglyceride production
May cause rhabdomyolysis when used together with a
statin
NICOTINIC ACID (NIACIN)
Requires high doses
Side effects include flushing and itching
Contraindicated in diabetes