Measurements-lipid disorders

腰圍: 體重*1/2 from ileic creast

• Lipoproteins = lipid core (cholesteryl esters & triglycerides) + phospholipid surface + proteins. Include: chylomicrons, VLDL, IDL, LDL, HDL, Lp(a)
• Measure after 12-h fast; LDL typically calculated: LDL-C = TC – HDL-C – (TG/5) underestim. if TG >400 or LDL-C <70 mg/dL; ∴ directly measure LDL-C levels stable up to 24 h after ACS, then ↓ and may take 6 wk to return to nl
• PEx clues: tendon xanthomas (eg, Achilles), imply LDL >300 mg/dL; eruptive xanthomas on extensor surfaces imply TG >1500 mg/dL; xanthelasma (yellowish streaks on eyelids)
• Metabolic syndrome
• Lp(a) = LDL particle + apo(a); concentration genetically determined; a/w CAD & AS

Timing of assessments

• ASCVD risk evaluations and discussions should begin at 20 years of age or at first encounter with the health care system beyond 20 years of age.
• ASCVD risk should be reassessed every four to six years in patients whose identified 10-year ASCVD risk is low (<5 percent) or borderline (5 to 7.4 percent) and more frequently for patients whose identified 10-year ASCVD risk is intermediate (7.5 to 19.9 percent), or following the identification of a new risk factor.
• The optimal time interval for reassessing risk in patients with intermediate 10-year ASCVD risk is uncertain.
• However, once a person reaches a threshold for lifestyle or pharmacologic intervention, the emphasis going forward should be placed on optimization of risk factors for that individual.