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Disorders of Lipoprotein Metabolism Discussion Disorders of Lipoprotein Metabolism Discussion Disorders of Lipoprotein Metabolism Discussion Description Select a disease of lipoprotein metabolism. Provide a brief review of the disorder, including a molecular and biochemical characterization as well as essential clinical features. Be sure to include relevant therapeutic strategies for managing the condition. The main disorders of lipid metabolism are LDL-hypercholesterolemia, hypertriglyceridemia, mixed hyperlipoproteinemia, and low HDL cholesterol. The lipoprotein(a) level can also be elevated either in isolation or in combination with other disorders of lipid metabolism. According to the current European recommendations, an LDL-cholesterol target value should be defined on the basis of the overall cardiovascular risk. If this risk is very high, as in patients with documented atherosclerosis, the target value should be set at <70 mg/dL (<1.8 mmol/L). If the risk is lower, higher target values can be set: <100 mg/dL (<2.6 mmol/L) or <115 mg/dL (<3.0 mmol/L). Lifestyle changes are an effective treatment mainly for patients with hypertriglyceridemia and mixed disorders of lipid metabolism. Lowering the LDL-cholesterol concentration with statins is by far the most important type of pharmacotherapy. Patients who cannot tolerate statins or whose cholesterol level is not adequately lowered can be given ezetimibe instead. PCSK9 antibodies have been available since the autumn of 2015; they can apparently lower the LDL-cholesterol level by more than 50%, but no endpoint trials have yet been reported. At present, they should only be given to carefully selected patients. Fibrates and omega-3 fatty acids have been found to prevent cardiovascular events in monotherapy trials but yield no added benefit when given together with statins. The design of these trials was faulty, however, and the utility of such combinations in patients with mixed disorders of lipid metabolism or hypertriglyceridemia cannot yet be definitively assessed. Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Disorders of Lipoprotein Metabolism Discussion The genetic findings would have been of little importance without confirmation by intervention studies. Thus, studies on statins first demonstrated a virtually linear association between reduction in LDL cholesterol and the rate of cardiovascular events (2). A statin-induced lowering of LDL cholesterol by 1 mmol/L (ca. 39 mg/dL) leads to a 22% reduction in relative risk. A new study investigating Disorders of Lipoprotein Metabolism Discussion the effect of ezetimibe has shown that this association also exists when the LDL reduction is brought about by a cholesterol adsorption inhibitor (IMPROVE-IT study) (8). An additional lowering of LDL cholesterol by 9% (from 69.5 mg/dL to 53.7 mg/dL) decreases the relative risk of a coronary event by 6.4% (absolute risk 32.7% versus 34.7%, number needed to treat [NNT] 350/year). Although the absolute effect is low, the study proves that a statin-independent lowering of LDL cholesterol can reduce the risk and it also shows that reduction of an already low LDL cholesterol level is reflected by a further decrease in risk. This has been confirmed by meta-analyses of statin studies (4, 9) and by data on new lipid-lowering agents (PCSK9 antibodies), which can induce an additional LDL cholesterol reduction of 50 to 60% and for which the approval studies indicate a greater than 50% decrease in risk (10, 11). However, these were not endpoint studies. Order Now