TABLE 35-3 Secondary causes of hyperlipoproteinemia. Hypertriglyceridemia Hypercholesterolemia Diabetes mellitus Hypothyroidism Alcohol ingestion Early nephrosis Severe nephrosis Resolving lipemia Estrogens Immunoglobuiln -lipoprotein complex disorders Uremia Anorexia nervosa HIV infection Cholestasis Myxedema Hypopituitarism Glycogen storage disease Corticosteroid excess Hypopituitarism Acromegaly Immunoglobulin-lipoprotein complex disorders Lipodystrophy Protease inhibitors TABLE 35-2 The primary hyperlipoproteinemias and their treatment. Disorders Manifestations Chylomicrons, VLDL increased Primary chylomicronemia (familial lipoprotein lipase or cofactor deficiency; others) Familial hypertriglyceridemiasevere moderate Familial combined hyperlipoproteinemia VLDL, chylomicrons increased VLDL increased: chylomicrons may be increased VLDL predominantly increased LDL predominantly increased VLDL, LDL increased Familial VLDL remnants, dysbetalipoprotenemia chylomicron remnants increased Familial hypercholestrolemia heterozygous LDL increased homozygous LDL increased Diet+ Single Drug' Drug Dietary management (omega-3 eppoten lpase or cofactor def. fatty acids, fibrate or niacin) Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or reductase inhibitor Reductase inhibitor, ezetimibe or niacin Omega-3 fatty acids, reductase inhibitor or niacin Omega-3 fatty acids, fibrate, reductase inhibitor or niacin Drug Combination Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide Niacin, atorvastin, rosuvastin, ezetimibe, Two or three of the individual drugs Fibrate plus niacin Fibrate plus niacin Fibrate plus niacin Two or three of the single agents Two or three of the single agents Niacin or fibrate plus reductase Reductase inhibitor plus fibrate or niacin Combinations of some of the single agents Familial liganddefective apo B Lp (a) Hyperlipoproteinemia LDL increased LP(a) increased mipomersen r lomitapide reductase inhibitor, niacin or ezetimibe, niacin Two or three of the single agents Single drug therapy with marine omega-3 dietary supplement should be evaluated before drug combinations are used TABLE 35-2 The primary hyperlipoproteinemias and their treatment. Disorders Manifestations Chylomicrons, VLDL increased Primary chylomicronemia (familial lipoprotein lipase or cofactor deficiency; others) Familial hypertriglyceridemiasevere moderate Familial combined hyperlipoproteinemia VLDL, chylomicrons increased VLDL increased: chylomicrons may be increased VLDL predominantly increased LDL predominantly increased VLDL, LDL increased Familial VLDL remnants, dysbetalipoprotenemia chylomicron remnants increased Familial hypercholestrolemia heterozygous LDL increased Diet+ Single Drug' Drug Dietary management (omega-3 eppoten lpase or cofactor def. fatty acids, fibrate or niacin) Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or reductase inhibitor Reductase inhibitor, ezetimibe or niacin Omega-3 fatty acids, reductase inhibitor or niacin Omega-3 fatty acids, fibrate, reductase inhibitor or niacin Drug Combination Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide Two or three of the individual drugs Fibrate plus niacin Fibrate plus niacin Fibrate plus niacin Two or three of the single agents Two or three of the single agents Niacin or fibrate plus reductase Reductase inhibitor plus fibrate or niacin homozygous LDL increased Familial liganddefective apo B Lp (a) Hyperlipoproteinemia LDL increased LP(a) increased Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide reductase inhibitor, niacin or ezetimibe, niacin Combinations of some of the single agents Two or three of the single agents Single drug therapy with marine omega-3 dietary supplement should be evaluated before drug combinations are used TABLE 35-2 The primary hyperlipoproteinemias and their treatment. Disorders Manifestations Chylomicrons, VLDL increased Primary chylomicronemia (familial lipoprotein lipase or cofactor deficiency; others) Familial hypertriglyceridemiasevere moderate Familial combined hyperlipoproteinemia VLDL, chylomicrons increased VLDL increased: chylomicrons may be increased VLDL predominantly increased LDL predominantly increased VLDL, LDL increased Familial VLDL remnants, dysbetalipoprotenemia chylomicron remnants increased Familial hypercholestrolemia heterozygous LDL increased Diet+ Single Drug' Drug Dietary management (omega-3 eppoten lpase or cofactor def. fatty acids, fibrate or niacin) Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or reductase inhibitor Reductase inhibitor, ezetimibe or niacin Omega-3 fatty acids, reductase inhibitor or niacin Omega-3 fatty acids, fibrate, reductase inhibitor or niacin Drug Combination Niacin, atorvastin, rosuvastin, ezetimibe, Two or three of the individual drugs Fibrate plus niacin Fibrate plus niacin Fibrate plus niacin Two or three of the single agents Two or three of the single agents Niacin or fibrate plus reductase Reductase inhibitor plus fibrate or niacin homozygous LDL increased Familial liganddefective apo B Lp (a) Hyperlipoproteinemia LDL increased LP(a) increased mipomersen r lomitapide Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide reductase inhibitor, niacin or ezetimibe, niacin Combinations of some of the single agents Two or three of the single agents Single drug therapy with marine omega-3 dietary supplement should be evaluated before drug combinations are used TABLE 35-2 The primary hyperlipoproteinemias and their treatment. Disorders Manifestations Chylomicrons, VLDL increased Primary chylomicronemia (familial lipoprotein lipase or cofactor deficiency; others) Familial hypertriglyceridemiasevere moderate Familial combined hyperlipoproteinemia VLDL, chylomicrons increased VLDL increased: chylomicrons may be increased VLDL predominantly increased LDL predominantly increased VLDL, LDL increased Familial VLDL remnants, dysbetalipoprotenemia chylomicron remnants increased Familial hypercholestrolemia Diet+ Single Drug' Drug Dietary management (omega-3 eppoten lpase or cofactor def. fatty acids, fibrate or niacin) Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or reductase inhibitor Reductase inhibitor, ezetimibe or niacin Omega-3 fatty acids, reductase inhibitor or niacin Omega-3 fatty acids, fibrate, reductase inhibitor or niacin Drug Combination Fibrate plus niacin Fibrate plus niacin Fibrate plus niacin Two or three of the single agents Two or three of the single agents Niacin or fibrate plus reductase Reductase inhibitor plus fibrate or niacin heterozygous LDL increased homozygous LDL increased Familial liganddefective apo B Lp (a) Hyperlipoproteinemia LDL increased LP(a) increased Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide reductase inhibitor, niacin or ezetimibe, niacin Two or three of the individual drugs Combinations of some of the single agents Two or three of the single agents Single drug therapy with marine omega-3 dietary supplement should be evaluated before drug combinations are used TABLE 35-2 The primary hyperlipoproteinemias and their treatment. Disorders Manifestations Chylomicrons, VLDL increased Primary chylomicronemia (familial lipoprotein lipase or cofactor deficiency; others) Familial hypertriglyceridemiasevere moderate Familial combined hyperlipoproteinemia VLDL, chylomicrons increased VLDL increased: chylomicrons may be increased VLDL predominantly increased LDL predominantly increased VLDL, LDL increased Familial VLDL remnants, dysbetalipoprotenemia chylomicron remnants increased Diet+ Single Drug' Drug Dietary management (omega-3 eppoten lpase or cofactor def. fatty acids, fibrate or niacin) Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or niacin Omega-3 fatty acids, fibrate, or reductase inhibitor Reductase inhibitor, ezetimibe or niacin Omega-3 fatty acids, reductase inhibitor or niacin Omega-3 fatty acids, fibrate, reductase inhibitor or niacin Drug Combination Fibrate plus niacin Fibrate plus niacin Fibrate plus niacin Two or three of the single agents Two or three of the single agents Niacin or fibrate plus reductase Reductase inhibitor plus fibrate or niacin Familial hypercholestrolemia heterozygous LDL increased homozygous LDL increased Familial liganddefective apo B Lp (a) Hyperlipoproteinemia LDL increased LP(a) increased Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide Niacin, atorvastin, rosuvastin, ezetimibe, mipomersen r lomitapide reductase inhibitor, niacin or ezetimibe, niacin Two or three of the individual drugs Combinations of some of the single agents Two or three of the single agents Single drug therapy with marine omega-3 dietary supplement should be evaluated before drug combinations are used
