Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- antecedentes familiares de cardiopatía coronaria o dislipidemia de inicio temprano en parientes de primer grado
- antecedentes de enfermedad cardiovascular
- consumo de grasas saturadas y ácidos grasos trans
- exceso de peso corporal (especialmente obesidad abdominal)
- xantelasmas
- xantomas tendinosos
Other diagnostic factors
- arco senil de la córnea con inicio antes de los 45 años de edad
- xantomas tuberosos
Risk factors
- resistencia a la insulina y diabetes mellitus tipo 2
- exceso de peso corporal (índice de masa corporal > 25 kg/m²)
- tabaquismo
- hipotiroidismo.
- hepatopatía colestásica
- síndrome nefrótico
- uso de ciertos medicamentos
Diagnostic investigations
1st investigations to order
- lipidograma
- hormona estimulante de la tiroides (TSH)
- lipoproteina (a)
Investigations to consider
- pruebas genéticas
Treatment algorithm
con ECVSA clínica: riesgo muy elevado
con ECVSA clínica: riesgo no muy elevado y edad ≤75 años
con ECVSA clínica: riesgo no muy alto y edad >75 años
sin ECVSA clínica: colesterol LDL≥4.9 mmol/L (≥190 mg/dL) sin diabetes mellitus (20-75 años)
sin ECVSA clínica: colesterol LDL ≥4.1 mmol/L (≥160 mg/dL) sin diabetes mellitus (edad 20-39 años)
sin ECVSA clínica: el colesterol LDL 1.8 a 4.9 mmol/L (70-189 mg/dL) sin diabetes mellitus (edad 40-75 años)
sin ECVSA clínica: colesterol LDL de1.8 a 4.9 mmol/L (70-189 mg/dL) sin diabetes mellitus (edad >75 años)
sin ECVSA clínica: con diabetes mellitus y potenciadores de riesgo (20-39 años)
sin ECVSA clínica: con diabetes mellitus, riesgo previsto de ECVSA a 10 años <7.5% y sin factores de riesgo (edad 40-75 años)
sin ECVSA clínica: con diabetes mellitus, riesgo predicho de ASCVD a 10 años ≥7.5% y potenciadores de riesgo (edad 40-75 años)
sin ECVSA clínica: con diabetes mellitus (edad >75 años)
hipercolesterolemia familiar
Contributors
Authors
Thorsten Leucker, MD, PhD
Assistant Professor of Medicine
Division of Cardiology, Department of Medicine
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
TL has received grant funding for his university from Amgen and Merck.
Richard A. Ferraro, MD
Cardiovascular Disease Fellow
Division of Cardiology, Department of Medicine
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
RAF declares that he has no competing interests.
Acknowledgements
Dr Thorsten Leucker and Dr Richard A. Ferraro would like to gratefully acknowledge Dr Seth S. Martin, Dr Rhanderson Cardoso, Dr Raul D. Santos, Dr Martin Engelhardt, and Dr Michael Miller, the previous contributors to this topic.
Disclosures
SSM has received honoraria from the American College of Cardiology for educational activities. SSM is listed as a co-inventor on a pending patent filed by Johns Hopkins University for a novel method of LDL-cholesterol estimation. SSM received a charitable gift for the VLDL big data project from the David and June Trone Family Foundation, and has also received research support from the PJ Schafer Cardiovascular Research Fund, American Heart Association, Aetna Foundation, iHealth, Stanford MedX/Nokia, Google, and Apple. SSM has acted as a consultant for Abbott Nutrition, Pressed Juicery, Quest Diagnostics, Sanofi/Regeneron, Amgen, Novo Nordisk, Esperian, Akcea, and the Pew Institute. RC declares that he has no competing interests. RDS has received honoraria for consulting, speaker activities and research from Astra Zeneca, Amgen, Akcea, Biolab, Esperion, Kowa, Pfizer, Merck, Novo-Nordisk, and Sanofi/Regeneron. ME declares that he has no competing interests. MM has received research grant support and honoraria for lectures from AstraZeneca, Merck-Schering Plough, and Pfizer. MM has received consulting fees from Pfizer, Merck-Schering Plough, and Roche.
Peer reviewers
Mahi Lakshmi Ashwath, MD
Assistant Professor of Medicine
Noninvasive Cardiology
MetroHealth Campus
Case Western Reserve University
Cleveland
OH
Disclosures
MLA declares that he has no competing interests.
Deepak Bhatnagar, TD MBBS PhD FRCP FRCPI FRCPath
Consultant/Senior Lecturer in Diabetes & Metabolism
The Royal Oldham Hospital & University of Manchester Cardiovascular Research Group Diabetes Centre
Royal Oldham Hospital
Oldham
UK
Disclosures
DB declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-88.Full text Abstract
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1082-143.Full text Abstract
National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification. Dec 2023 [internet publication].Full text
Expert Dyslipidemia Panel of the International Atherosclerosis Society Panel members. An International Atherosclerosis Society position paper: global recommendations for the management of dyslipidemia - full report. J Clin Lipidol. 2014 Jan-Feb;8(1):29-60.Full text Abstract
Writing Committee; Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC Expert Consensus Decision Pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 Oct 4;80(14):1366-418.Full text Abstract
Cholesterol Treatment Trialists' (CTT) Collaboration; Fulcher J, O'Connell R, Voysey M, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015 Apr 11;385(9976):1397-405. Abstract
Grundy SM, Cleeman JI, Mertz CN, et al; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004 Jul 13;110(2):227-39.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hepatopatía obstructiva
- Síndrome nefrótico
- Fallo renal crónico
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Colesterol alto
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