Hiperlipidemia: Perbedaan antara revisi
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==Klasifikasi==
Hiperlipidemia pada dasarnya dapat diklasifikasikan sebagai familial (juga disebut primer[9]) ketika disebabkan oleh kelainan genetik tertentu atau didapat (juga disebut sekunder)[9] ketika diakibatkan oleh kelainan lain yang menyebabkan perubahan dalam metabolisme lipid plasma dan lipoprotein.[9] Selain itu, hiperlipidemia dapat bersifat idiopatik, yaitu tanpa penyebab yang diketahui.[10]
Hiperlipidemia juga diklasifikasikan menurut jenis lipid yang meningkat, yaitu hiperkolesterolemia, hipertrigliseridemia atau keduanya dalam hiperlipidemia gabungan. Kadar Lipoprotein(a) yang meningkat juga dapat diklasifikasikan sebagai bentuk hiperlipidemia.[11]
[[File:Hyperlipidemia classification.png|thumb|Klasifikasi hiperlipidemia]]
===Familial (primer)===
Hiperlipidemia familial diklasifikasikan menurut klasifikasi Fredrickson, yang didasarkan pada pola lipoprotein pada elektroforesis atau ultracentrifugasi.[12] Klasifikasi ini kemudian diadopsi oleh Organisasi Kesehatan Dunia (WHO).[13]
{| class="sortable wikitable"
|+ '''Fredrickson classification of hyperlipidemias'''
|-
! colspan="2" | Hyperlipo-<br>proteinemia
! [[OMIM]]
! Synonyms
! Defect
! Increased lipoprotein
! Main symptoms
! Treatment
! Serum appearance
! Estimated prevalence
|-
! rowspan="3" | [[Type I hyperlipoproteinemia|Type I]]
! [[Hyperlipoproteinemia type Ia|a]]
| {{OMIM|238600||none}}
| Buerger-Gruetz syndrome or familial hyperchylomicronemia
| Decreased [[lipoprotein lipase]] (LPL)
| rowspan="3" | [[Chylomicrons]]
| rowspan="3" | [[Acute pancreatitis]], [[lipemia retinalis]], eruptive skin [[xanthoma]]s, [[hepatosplenomegaly]]
| rowspan="3" | Diet control
| rowspan="3" | Creamy top layer
| rowspan="3" | One in 1,000,000<ref>{{cite web | title = Hyperlipoproteinemia, Type I | date = 6 March 2007 | url = http://www.cags.org.ae/FMPro?-DB=ctga.fp5&-Format=ctga%2Fctga_detail.html&-RecID=34563&-Find | archive-url = https://web.archive.org/web/20120327213629/http://www.cags.org.ae/FMPro?-DB=ctga.fp5&-Format=ctga%2Fctga_detail.html&-RecID=34563&-Find | archive-date=27 March 2012 | work = Centre for Arab Genomic Studies | quote = About 1:1,000,000 people are affected with Hyperlipoproteinemia type I worldwide with a higher prevalence in some regions of Canada. }}</ref>
|-
! [[hyperlipoproteinemia type Ib|b]]
| {{OMIM|207750||none}}
| Familial apoprotein CII deficiency
| Altered [[apolipoprotein C2|ApoC2]]
|-
! [[Hyperlipoproteinemia type Ic|c]]
| {{OMIM|118830||none}}
|
| [[Lipoprotein lipase|LPL]] inhibitor in blood
|-
! rowspan="2" | Type II
! a
| {{OMIM|143890||none}}
| [[Familial hypercholesterolemia]]
| [[LDL receptor]] deficiency
| [[LDL]]
| [[Xanthelasma]], [[arcus senilis]], tendon xanthomas
| [[Bile acid sequestrant]]s, [[statin]]s, [[niacin (substance)|niacin]]
| Clear
| One in 500 for heterozygotes
|-
! b
| {{OMIM|144250||none}}
| Familial combined hyperlipidemia
| Decreased [[LDL receptor]] and increased [[apolipoprotein B|ApoB]]
| [[LDL]] and [[VLDL]]
|
| Statins, niacin, [[fibrate]]
| Turbid
| One in 100
|-
! colspan="2" | Type III
| {{OMIM|107741||none}}
| [[Familial dysbetalipoproteinemia]]
| Defect in [[apolipoprotein E|Apo E 2]] synthesis
| [[Intermediate density lipoprotein|IDL]]
| Tuberoeruptive xanthomas and palmar xanthomas
| Fibrate, statins
| Turbid
| One in 10,000<ref name="fung2011">{{cite journal | vauthors = Fung M, Hill J, Cook D, Frohlich J | title = Case series of type III hyperlipoproteinemia in children | journal = BMJ Case Reports | volume = 2011 | pages = bcr0220113895 | date = June 2011 | pmid = 22691586 | pmc = 3116222 | doi = 10.1136/bcr.02.2011.3895 }}</ref>
|-
! colspan="2" | Type IV
| {{OMIM|144600||none}}
| [[Familial hypertriglyceridemia]]
| Increased VLDL production and decreased elimination
| VLDL
|Can cause [[pancreatitis]] at high triglyceride levels
| Fibrate, niacin, statins
| Turbid
| One in 100
|-
! colspan="2" | [[#type V|Type V]]
| {{OMIM|144650||none}}
|
| Increased VLDL production and decreased [[Lipoprotein lipase|LPL]]
| VLDL and chylomicrons
|
| Niacin, fibrate
| Creamy top layer and turbid bottom
|
|}
==Pemeriksaan/Diagnosis==
Orang dewasa berusia 20 tahun ke atas harus memeriksakan kolesterol setiap empat hingga enam tahun.<ref name=":11">{{Cite web|title=What Your Cholesterol Levels Mean|url=https://www.goredforwomen.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean|website=www.goredforwomen.org|language=en|access-date=2020-04-30}}</ref> Kadar serum kolesterol [[lipoprotein densitas rendah]] (LDL), kolesterol [[lipoprotein densitas tinggi]] (HDL), dan trigliserida biasanya diuji dalam pengaturan perawatan primer menggunakan panel lipid.<ref>{{Cite web|title=Cholesterol testing and results: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/patientinstructions/000386.htm|website=medlineplus.gov|language=en|access-date=2020-04-30}}</ref> Kadar kuantitatif lipoprotein dan trigliserida berkontribusi terhadap stratifikasi risiko penyakit kardiovaskular melalui model/kalkulator seperti ''Framingham Risk Score'', ''ACC/AHA Atherosclerotic Cardiovascular Disease Risk Estimator'', dan/atau ''Reynolds Risk Scores''. Model/kalkulator ini juga dapat memperhitungkan riwayat keluarga (penyakit jantung dan/atau kolesterol darah tinggi), usia, jenis kelamin, Indeks Massa Tubuh, riwayat medis (diabetes, kolesterol tinggi, penyakit jantung), kadar [[Protein C-reaktif|CRP]] sensitivitas tinggi, skor kalsium arteri koroner, dan indeks ''ankle-brachial''.<ref name=":2">{{cite journal | vauthors = Kopin L, Lowenstein C | title = Dyslipidemia | journal = Annals of Internal Medicine | volume = 167 | issue = 11 | pages = ITC81–ITC96 | date = December 2017 | pmid = 29204622 | doi = 10.7326/AITC201712050 }}</ref> Stratifikasi kardiovaskular selanjutnya menentukan intervensi medis apa yang mungkin diperlukan untuk menurunkan risiko penyakit kardiovaskular di masa mendatang.<ref>{{Cite journal |last=US Preventive Services Task Force |date=2022-08-23 |title=Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement |url=https://jamanetwork.com/journals/jama/fullarticle/2795521#:~:text=Recommendation%20The%20USPSTF%20recommends%20that,I%20statement) |journal=JAMA |volume=328 |issue=8 |pages=746–753 |doi=10.1001/jama.2022.13044 |pmid=35997723 |issn=0098-7484}}</ref>
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