Medical Council of Canada

Medical expert

Abnormal, Serum Lipids - 51

Rationale

Hypercholesterolemia is a common and important modifiable risk factor for ischemic heart disease, cerebrovascular disease and peripheral vascular disease. Determination of levels is usually based upon concomitant risk factors.

Causal Conditions

(list not exhaustive)
  1. Hypercholesteremia (elevated low-density lipoprotein, lipoprotein (a))
    1. Primary causes
      1. Familial combined hyperlipidemia
      2. Polygenic
      3. Familial hypercholesterolemia
    2. Secondary causes
      1. Endocrine (e.g.,diabetes mellitus, hypothyroidism)
      2. Cholestatic liver disease
      3. Nephrotic syndrome, chronic kidney injury
      4. Other
        1. Cigarettes
        2. Obesity
        3. Drugs (e.g., steroids)
  2. Hypertriglyceridemia
    1. Primary causes (familial hypertriglyceridemia)
    2. Secondary causes
      1. Obesity
      2. Diabetes mellitus
      3. Nephrotic syndrome, chronic kidney injury
      4. Drugs (e.g., estrogen)
      5. Alcohol
  3. Low high-density lipoprotein
    1. Primary
    2. Secondary
      1. Obesity
      2. Drugs (e.g., anabolic steroids)
      3. Metabolic syndrome

Key Objectives

Given a patient with abnormal serum lipids, the candidate will diagnose the cause, severity, and complications. In particular, the candidate will identify those patients who will benefit from serum cholesterol reduction, as well as both primary and secondary prevention.

Enabling Objectives

Given a patient with abnormal serum lipids, the candidate will

  1. list and interpret critical clinical findings, including
    1. perform a history and physical examination to identify patients with remediable causes for their lipid abnormalities (e.g., hypothyroidism);
    2. select patients at highest risk for subsequent development of ischemic heart disease for drug therapy (e.g., Framingham risk calculation);
  2. list and interpret critical investigations, including
    1. further laboratory testing to identify patients with remediable causes for their lipid abnormalities;
  3. construct an effective initial management plan, including
    1. recommend lifestyle modification and pharmacologic therapy as appropriate;
    2. discuss risks and benefits of primary versus secondary prophylaxis with lipid-lowering drugs;
    3. select patients in need of specialized care.
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