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1 PI24 ENDOCRINOLOGA Dislipidemia Riesgo cardiovascular
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1 PI24 ENDOCRINOLOGA Dislipidemia Riesgo cardiovascular

Understanding Dyslipidemia and Cardiovascular Risk

Overview of Dyslipidemia Types

  • Dyslipidemia is discussed in relation to cardiovascular risk, noting that not all types pose the same level of risk. Specifically, Type 1 and Type 5 (Friedewald) dyslipidemias do not elevate cardiovascular risk.

Mechanism of Cardiovascular Risk

  • The process begins with endothelial dysfunction leading to the generation of oxidized LDL and infiltration of monocytes, which ultimately form foam cells. This inflammatory process contributes to cholesterol plaque deposition, potentially resulting in myocardial infarction or cerebral infarction as plaques destabilize.

Assessing Cardiovascular Risk

  • Cardiovascular risk can be quantified using a risk calculator developed by the American Heart Association, providing a percentage chance of mortality over ten years. A score below 5% indicates no need for intervention; scores between 5% and 20% require further evaluation. Scores above 20% suggest high-intensity interventions are necessary.

Additional Risk Factors

  • Beyond calculated risks, additional factors must be considered:
  • Family history of premature cardiovascular disease (e.g., male relatives before age 55 or female relatives before age 65).
  • Primary hypercholesterolemia types (2A and 2B) versus polygenic forms.
  • Metabolic syndrome and chronic kidney disease significantly increase cardiovascular mortality rates.

Inflammatory Conditions Impacting Risk

  • Chronic inflammatory conditions such as rheumatoid arthritis (RA), lupus, HIV, and psoriasis heighten cardiovascular risks due to ongoing inflammation.
  • Notably, RA has been linked to increased myocardial infarction rates.
  • Early menopause (before age 40) also raises cardiovascular risk levels among women.

Important Lipid Biomarkers

  • Key lipid biomarkers include:
  • Persistently high triglycerides (>175 mg/dL).
  • Elevated Apo B (>130 mg/dL).
  • High C-reactive protein levels (>2 mg/L).
  • Ankle-brachial index measurements indicating peripheral arterial disease when below 0.9.

These markers are crucial for assessing overall cardiovascular health and guiding treatment decisions. The use of Doppler ultrasound technology is emphasized for accurate measurement in clinical settings.