dyslipidemia

LEARNING OBJECTIVES:

KNOWLEDGE:

1. In order to understand the diagnostic and treatment plans for dyslipidemias the student will describe lipoprotein structure by completely the blanks on Figure 1, which is a Very Low Density Lipoprotein.
2. The exogenous and endogenous lipid pathways should be able to be drawn including identification of the key enzymes in the metabolism. This is demonstrated by the completion of Figure 2.
3. Identify the major apoproteins on HDL, VLDL, LDL and chylomicrons.
4. List the resultant lipoprotein accumulation when there is a defect of:
   • Lipoprotein lipase
   • Defective apolipoprotein CII
   • Deficient or defective apolipoprotein B-100
   • Deficient LDL receptors
   • Defective conversion of VLDL to LDL
5. From the lecture on coronary artery disease review Figure 241-1 and describe the central role lipoproteins have in the initiation and evolution of atheroma.
6. Describe the secondary causes of dyslipidemias and their mechanism for abnormal lipoprotein metabolism.
7. Describe and define the components of a lipid profile.
8. List the major components of the Step 1 and Step 2 as described by the National Cholesterol Education Program (NCEP) and bring in three food labels to review with the class.
9. Describe the 4 major drug classes used in the treatment of dyslipidemias with their mode of action, lipoprotein class affected, side effects, and contraindications.
10. Table 344-1 lists the major lipid lowering trials. The student will know the difference between primary and secondary prevention. They will also be able to describe the relative and absolute risk reduction of major trials.

PATIENT CARE SKILLS:

1. Perform the appropriate history to identify a potential familial dyslipidemia.
2. Perform a thorough examination for evidence of dyslipidemias including:
   • Fundal exam for lipemic retanalis
   • Tendons for Xanthomas
   • Skin for Xanthalasmas, palmar discoloration
   • Visual inspection of serum and the correlation to the lipid profile
3. Visual inspection of serum and the correlation to the lipid profile

ATTITUDES AND PROFESSIONAL BEHAVIORS:

CAD and dyslipidemias are the most talked about and noticeable risk factor for CAD. Students must recognize the importance of this risk factor and begin to develop a working knowledge for dietary counseling, along with appropriate drug therapy. Giving everyone a "statin" is not the answer. The student will be able to approach each patient, identify potential dyslipidemias, and give individualized dietary and drug therapy.

REFERENCES

1. Harrison’s Principles of Internal Medicine  15^th Edition, Pages 2245-2257