Unstable angina

• Chronic stable angina

Table 12-3 Secondary Conditions and Drugs That May Cause Hyperlipidemias

t ldl

Ihdl

Cholesterol

" Triglycerides

Cholesterol

Diabetes

V

V

Hypothyroidism

V

V

Obstructive liver

V

disease/biliary

cirrhosis

Renal disease

V

Nephrotic

yj

V

syndrome

Chronic renal

V

failure

Hemodialysis

V

patients

Obesity

V

V

Drugs:

Estrogen

V

Progestins

V

V

Protease inhibitors

V

V

Anabolic steroids

yj

n/

Corticosteroids

V

V

Isotretinoin

V

V

Cyclosporine

V

Atypical

V

V

antipsychotics

Thiazide diuretics

V

ß-Blockers

V

V

• Coronary interventions (coronary bypass, percutaneous transluminal coronary an-gioplasty, or stents)

• Peripheral arterial disease (claudication or ankle-brachial index less than 0.9)

• Symptomatic carotid artery disease (stroke or transient ischemic attack)

• Multiple risk factors with a Framingham calculated risk (Fig. 12-6) greater than 20%

^^ The benefits of lowering LDL cholesterol to as low as 70 mg/dL (1.81 mmol/ L) have been demonstrated in clinical trials. Thus, in patients considered very high risk, an LDL cholesterol goal of less than 70 mg/dL (1.81 mmol/L) is a therapeutic option.9,10 These individuals have established CAD or present with acute coronary syndromes. The lowest level of LDL cholesterol where there is no further reduction in CHD risk has not yet been determined.

Step 4: Determine the Presence of Major Risk Factors

In individuals who do not have established CHD or CHD risk equivalent, the next step is to count major risk factors for CHD as presented in Table 12-4. These risk factors are considered independent predictors of CHD. HDL cholesterol of greater than or equal to 60 mg/dL (1.55 mmol/L) is considered a negative risk factor and means one risk factor can be subtracted from the total count.

Step 5: If Two or More Risk Factors Are Present Without CHD or CHD Risk Equivalent, Assess 10-Year CHD Risk

Listed in Table 12-5 are the risk groups that require risk calculations using the Fram-ingham scoring system. Because individuals with two or more risk factors may carry a risk equivalent to individuals with established CHD, and therefore should be treated with the same intensity, a scoring system developed from the Framingham Coronary Heart Disease Study is used to estimate this 10-year risk (Fig. 12-6). This system assigns points to the following risk factors: age, total cholesterol level, smoking status, HDL cholesterol level, and systolic blood pressure. The score is used to determine a patient's risk category and the intensity of treatment to lower their LDL cholesterol. To calculate a Framingham score, visit the following website: http://www.nhlbi.nih.gov/ guidelines/cholesterol/index.htm.

Step 6: Determine Treatment Goals and Therapy

Treatment goals for LDL cholesterol and thresholds for the institution of therapeutic lifestyle changes (TLC) and pharmacotherapy is the next step (Table 12-6).

Step 7: Initiate TLC If LDL Is Above Goal

Blood Pressure Health

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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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