51成人动漫

A recent from the Obesity Medicine Association and the National Lipid Association on obesity and dyslipidemia shines more light onto a common consequence of obesity and risk factors for coronary artery disease. The review reinforces the idea that we all often think of, that obesity contributes to dyslipidemia, resulting in the lipid profile of elevated triglycerides, low high-density lipoprotein (HDL), and high low-density lipoprotein (LDL). Collectively our mind first goes to "increased cardiovascular risk."

Triglycerides make up 90% of the volume of white adipose tissue. Among patients with increased adiposity, there is an increased risk of atherogenic dyslipidemia. This type of dyslipidemia includes elevated triglycerides, reduced HDL, increased lipoprotein (a), and LDL particles leading to increased risk of atherosclerosis.

Weight reduction is emphasized as a critical intervention, with even modest losses (5%) reducing triglycerides and more substantial losses (10-15%) improving HDL and lowering cardiovascular disease (CVD) risk. The importance of advanced lipid markers, such as ApoB and lipoprotein (a), is also stressed, suggesting they may provide more precise cardiovascular risk assessments than standard lipid panels.

More providers may start seeing the benefit of ordering ApoB and lipoprotein (a) in addition to lipid panels to further assess cardiovascular risk, just as we are recommending patients to get coronary calcium scans.

The review also acknowledges the significant impact of obesity on pediatric populations, warning that rising pediatric obesity increases the risk of early-onset diabetes and dyslipidemia. Monitoring children's lipid profiles is key to preventing long-term cardiovascular risks.

The experts also advocate for both lifestyle interventions and pharmacological options, including medications and bariatric surgery, to address obesity-related dyslipidemia and improve lipid profiles.

In summary, the expert review reminds clinicians that excess adiposity leads to an atherogenic lipid profile, leading to increased cardiovascular risk. It supports a multifaceted approach to managing dyslipidemia in patients with obesity, aiming for weight loss through a combination of lifestyle changes, medications, and surgical options.

My takeaway is to remind myself to think about other testing that can be done to further assess CV risk and to monitor my pediatric patients, teaching them early healthy lifestyle changes in order to prevent long-term health complications.

Raghuveer Vedala, MD, FAAFP, DABOM, a Family Medicine and Obesity Medicine Specialist, is a clinical physician (outpatient) at Norman Regional Health (South OKC) in Oklahoma City.

Read the review here and an interview about it here.