the lipid panel what are we missing? robert st. amant, md, faafp diplomate, american board of...
TRANSCRIPT
![Page 1: THE LIPID PANEL What are we missing? Robert St. Amant, MD, FAAFP Diplomate, American Board of Clinical Lipidology Baton Rouge General Medical Director,](https://reader035.vdocuments.net/reader035/viewer/2022062716/56649e045503460f94aefaf9/html5/thumbnails/1.jpg)
THE LIPID PANEL
What are we missing?
Robert St. Amant, MD, FAAFPDiplomate, American Board of Clinical Lipidology
Baton Rouge General Medical Director, Lipid Center
Womack Heart Center
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Conflict of Interest Statement: Speakers Bureau for the following companies:
• Abbott Laboratories
• CardioDx
• Kowa/Lilly
• Berkeley HeartLab
Clinical Investigator:• CardioDx
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Audience Objectives:
Have a better understanding of the standard lipid panel and cardiovascular disease risks.
Be able to discuss the relationship between cholesterol and lipoproteins and why patients with normal lipid panels have cardiovascular events.
Explore more advanced cholesterol, biomarker, and genetic tests available to enhance cardiovascular disease risk assessment.
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The Lipid Panel
Total Cholesterol Triglycerides HDLc LDLc
…….What’s missing?
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Cholesterol
Cell structure Sex hormones Bile acids Vitamin D
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Total Cholesterol
Structure Sources NCEP goal?
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Triglycerides
Structure Sources Purpose NCEP target
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HDL cholesterol
Structure Sources Purpose NCEP target
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LDL cholesterol
Structure Sources Purpose Primary NCEP ATPIII goal
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Non-HDL Cholesterol
What??? “New” 5th lipid fraction ALL BAD cholesterol, not just LDLc. Atherogenic lipoprotein particles Residual risk Secondary NCEP goal: 30mg/dL above LDLc goal
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NCEP ATPIII LDLc Goals:
CHD/CHD risk equivalents Moderate CHD risk Low CHD risk Non-HDLc goal TG primary goal
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CVD Risk Factors
Smoking Age >/=45M, 55F HPT >/=140/90 Low HDL <40* Family Hx CAD Age <55M, <65F
* HDL >/= 60 is a negative risk factor
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Lipoproteins
Insolubility Lipid trafficking vehicles ApoA and ApoB Interheart Study ApoB/ApoA
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ApoB Lipoproteins
Size Composition Atherogenic Discordance LDLc, LDLp, MIs
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ApoA Lipoproteins
Protective HDL cholesterol Functions Quantity vs Quality HDLc vs HDLp Protein Cargo
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Atherosclerosis
Complex process Progressive Inflammatory Endothelial dysfunction Atheroma burden Plaque rupture
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Risk Factors
Lifestyles Non-modifiable Modifiable Insulin resistance
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Insulin Resistance
Definition Diagnosis Prevalence 70% of MIs Treatment
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Metabolic Syndrome
5 Criteria 3/5 = diagnosis 1/3 adults Screening CAD & DM risks
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Looking Beyond the Lipid Panel
Using Selected Biomarkers Not for low risk patients Diligent risk evaluation Residual risk on statin therapy
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Advanced Cholesterol Testing
Beyond the lipid panel Not for everyone Intermediate and high risk patients Affordable Part of “What’s Missing?”
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Lp(a)
LDL particle with an apo(a) protein Very atherogenic Disrupts process of fibrinolysis MI/stroke risk CV events with normal lipids
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Lp-PLA2
Enzyme on LDLp Rapid plaque formation Prone to rupture MI / stroke risk Treat BP/meds
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SLCO1B1 Genotype
Gene variation for OATP Increased level statin drug Myalgia risk Statin “intolerance”
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Thank You!
Questions?