Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Dyslipidemia

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In one line

·Too much LDL cholesterol in the blood lets fat stick to artery walls and block blood flow to the heart and brain.

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Normal physiology

·Your liver makes cholesterol every day and wraps it into tiny particles so it can travel through your blood. LDL particles deliver cholesterol to cells that need it, and HDL particles pick up extra cholesterol and bring it back to the liver to be thrown out. Your liver has special hooks (LDL receptors) on its surface that grab LDL particles and pull them out of the blood, keeping cholesterol levels low and safe.

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What goes wrong

·When your liver does not have enough hooks to pull LDL out, or when it makes too much cholesterol, or when the LDL particles themselves change shape and become stickier, LDL builds up in your blood and slips into artery walls.

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Hallmark signs

·Usually no symptoms at all
·Xanthomas (small yellow bumps on skin, especially over tendons)
·Xanthelasma (yellowish patches on eyelids)
·Corneal arcus (white or gray ring around the colored part of the eye)
·Pancreatitis (sudden, severe belly pain that may reach through to the back)
·Chest pain or pressure (angina)
·Early heart attack or stroke in family members

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Red flags · escalate now

·Sudden severe belly pain with nausea and vomiting (may be pancreatitis from very high triglycerides)
·Chest pain, pressure, or tightness, especially with activity or stress (sign that plaque is blocking heart arteries)
·Sudden weakness, numbness, slurred speech, or vision loss (possible stroke from a clot breaking off plaque)
·Multiple close family members with heart attack or stroke before age 55 in men or 65 in women (suggests inherited severe high cholesterol)
·Triglycerides above 1,000 mg/dL (high risk of pancreatitis)

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Workup

·Lipid panel can be fasting or non
·Use CAC for borderline
·The question is always
·Lipid panel can be fasting or non
·Use CAC for borderline

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Treatment

·High-intensity statin (atorvastatin 40-80mg or rosuvastatin 20-40mg daily)
·Lifestyle changes: Mediterranean diet, 150 minutes exercise per week, weight loss, smoking cessation
·Ezetimibe (10mg daily) if LDL stays above goal after statin
·PCSK9 inhibitor (evolocumab or alirocumab) for familial hypercholesterolemia or ASCVD with LDL >70 despite statin + ezetimibe
·Icosapent ethyl (2g twice daily) or fibrate (fenofibrate) if triglycerides >200 despite statin
·Calculate 10-year ASCVD risk and check lipid panel every 4–12 weeks after starting or changing therapy

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NCLEX trap

·Start treatment now, before symptoms appear. Plaque builds up silently inside blood vessels. By the time chest pain starts, the vessel is almost blocked. We treat high LDL cholesterol (the 'bad' cholesterol) to prevent heart attacks, not to treat them after they happen.
·Keep the statin going. High cholesterol causes no symptoms. Feeling fine does not mean the LDL is gone or the plaque has stopped growing. Check the lipid panel (blood test) to see if the goal is reached, not how the patient feels.
·Match the statin dose to the patient's risk. If the patient has familial hypercholesterolemia (a gene that causes very high cholesterol) or already had a heart attack, use high-intensity statin. If the patient is young with no heart disease history, moderate-intensity may be enough. Use the ASCVD risk calculator (a tool that predicts heart attack risk over 10 years) to guide the choice.
·If LDL is not at goal on a statin, first raise the statin dose. If it is still high, add ezetimibe (blocks cholesterol from being absorbed in the gut) or a PCSK9 inhibitor (helps the liver clear LDL from the blood). Layering medicines is better than switching.
·Start lifestyle changes and medicine together. High cholesterol is often genetic (passed down in families). Even if the patient is thin and exercises, LDL may not come down enough. Medicine protects the heart while the patient works on diet and exercise.
·Check triglycerides too. High triglycerides (another type of fat in the blood) plus low HDL (the 'good' cholesterol) also increase heart risk. If triglycerides are very high (above 500), add a fibrate or icosapent ethyl to the statin to lower stroke and heart attack risk.

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