This paper discusses hyperlipidemia and evaluates clinical practice guidelines used in the management of hyperlipidemia.
Evaluation of Clinical Practice Guideline
Clinical practice guidelines (CPG) aim to standardize decision-making and optimize the quality of care. CPG is based on comprehensive research and the principles of evidence-based practice (AAFP.org, n.d.). CPG contains metrics that should be achieved and easily measured.
The healthcare problem of concern is hyperlipidemia. It is marked by elevated levels of lipids in the blood. Notably, total cholesterol levels are elevated beyond 200 mg/dl (Su et al., 2021). Also, low-density lipoproteins (LDL) are higher than 100 mg/dl, whereas high-density lipoproteins (HDL) are below 50 mg/dl (Su et al., 2021). On the other hand, triglyceride (TG) levels are usually more than 150 mg/dl (Su et al., 2021). However, it is worth noting that patients with elevated blood TG levels remain asymptomatic until they exceed 1000 mg/dl (Su et al., 2021).
Hill and Bordoni (2022) report that genetic factors are linked to primary hyperlipidemia (PH). Primary hyperlipidemia is common among teenagers and young adults and predisposes patients to cardiovascular complications (Hill & Bordoni, 2022). It can be broadly classified into six types. Firstly, Type I presents with high levels of TGs, chylomicrons, and cholesterol (Ballout & Remaley, 2021). In this context, TG levels exceed 1000 mg/dl (Ballout & Remaley, 2021). Type I PH is associated with a lower risk of atherosclerosis than other PH types (Ballout & Remaley, 2021). Secondly, type II PH presents elevated levels of LDL and cholesterol (Ballout & Remaley, 2021). Thirdly, type II b PH presents elevated levels of LDL, cholesterol, VLDL (very low-density lipoproteins), and TGs (Ballout & Remaley, 2021). Fourthly, type III PH is characterized by elevated levels of intermediate-density lipoproteins, cholesterol, and TGs (Ballout & Remaley, 2021). Notably, total cholesterol levels exceed 300 mg/dl, whereas TG levels exceed 400mg/dl (Ballout & Remaley, 2021). Also, type III PH is common in people with comorbidities such as diabetes mellitus, hypothyroidism, and obesity. Fifthly, type IV PH presents with elevated VLDL and TGs (Ballout & Remaley, 2021). Lastly, type V PH presents with high levels of VDL, cholesterol, chylomicrons, and TGs (Ballout & Remaley, 2021).
On the other hand, environmental factors have been linked to acquired hyperlipidemia (AH). AH is caused by an individual’s lifestyle, underlying conditions, and medications. Examples of medications that have been implicated include glucocorticoids, antiretroviral, amiodarone, and hormonal contraceptives (Su et al., 2021). Examples of lifestyle factors include limited exercise, smoking, obesity, binge drinking, and unhealthy dietary habits (Su et al., 2021). Underlying medical conditions that increase the likelihood of AH include diabetes mellitus (DM), hypothyroidism, polycystic ovary syndrome, and renal disease (Ballout & Remaley, 2021).
CDC.gov (2023) reports that about ninety-four million people aged 20 years and above in the USA have elevated cholesterol levels (more than 200 mg/dl). Also, about 28 percent of this population has cholesterol levels that exceed 240 mg/dl (CDC.gov, 2023). About 7 percent of teenagers and children have elevated cholesterol levels (CDC.gov, 2023). In addition, approximately forty-seven million people are taking lipid-lowering medications (CDC.gov, 2023). According to CDC.gov (2023), the prevalence of elevated cholesterol levels is highest in Mississippi, Arkansas, and Louisiana. Hill and Bordoni (2022) report that the prevalence of hyperlipidemia is higher among males than females in the USA. CDC.gov (2023) reports that the prevalence is higher among non-Hispanic Asians, non-Hispanic whites, and Hispanics compared to non-Hispanic blacks. Hyperlipidemia predisposes patients to conditions such as stroke and heart disease. CDC.gov (2023) reports that stroke ranks fifth among the leading causes of mortalities in the USA, whereas heart disease ranks first.
As stated earlier, hyperlipidemia presents with elevated levels of cholesterol or TGs. Furthermore, it is marked by increased VLDL production, low HDL levels, and elevated LDL (Su et al., 2021). Elevated VLDL production is driven by lifestyle factors, genetic factors, and underlying medical conditions (Su et al., 2021). HDL facilitates the transfer of peripheral cholesterol to the hepatic system for metabolisms, whereas LDL transports cholesterol from the hepatic system to peripheral sites (Su et al., 2021). Elevated cholesterol damages vascular endothelium, leading to macrophage engulfment, oxidative stress, and secretion of inflammatory mediators such as cytokines (Su et al., 2021). This is succeeded by the proliferation of vascular muscle and plaque formation (Su et al., 2021). Continued plaque formation narrows arterial wall diameter (Su et al., 2021). Plaque rupture increases