Dyslipidemia
Özet
This chapter provides a comprehensive overview of dyslipidemia, focusing on the classification, risk assessment, and pharmacological management of lipid disorders to prevent atherosclerotic cardiovascular disease (ASCVD). Lipoproteins are characterized by their physical and chemical properties, noting that all non-HDL particles containing ApoB carry atherogenic risks. Dyslipidemic conditions include hypercholesterolemia and severe hypertriglyceridemia, which can arise from genetic factors or secondary causes such as a sedentary lifestyle, pregnancy, or drugs like glucocorticoids. Cardiovascular risk stratification is central to treatment, with major guidelines—such as the European Society of Cardiology (ESC) and the American Association of Clinical Endocrinologists (AACE)—utilizing risk scores like SCORE and Framingham to establish specific LDL-C, non-HDL-C, and ApoB targets. Pharmacotherapy follows an algorithmic approach where statins remain the first-line defense, followed by ezetimibe, PCSK9 inhibitors, or bempedoic acid for patients unable to achieve targets. For severe hypertriglyceridemia, fibric acid derivatives and omega-3 fatty acids are recommended to reduce pancreatitis risks. Finally, the text addresses statin intolerance, emphasizing that true intolerance is rare, often tied to a nocebo effect, and manageable through lower dosing or alternative regimens.
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