Diagnosis of Lipedema
There are different types of cholesterol and their abnormal levels have clinical relevance to the risk of cardiovascular disease. All patients >20 years of age should have an assessment for risk of cardiovascular disease (CVD), since the earliest stages of dyslipidemia begin in childhood. When lipid levels are abnormal enough to identify those who statistically have an elevated risk of having a CVD event in the next 10 years, it should prompt treatment with lipid-lowering medicines.
Those at higher risk for CVD should also be evaluated using the lipid profiles:
- Strong family history of dyslipidemia, atherosclerosis, heart disease, stroke, or arterial disease.
- Obese patients.
Statins are the most powerful drugs for reconciling lipid abnormalities to normal levels. Periodic lipid tests are done that assess total cholesterol, LDL-C, HDL-C, non-HDL cholesterol (total cholesterol minus HDL-C), and triglycerides after a diagnosis of hyperlipidemia is made and statins are begun.
A lipid panel that measures LDL-C, HDL-C, and triglycerides is used to establish the diagnosis as well as identify the severity of disease, based on the values attained for
- Total cholesterol (normal < 200 mg/dL)
- LDL cholesterol levels > 130mg/dL raise the risk for heart attacks, strokes, and other cardiovascular complications
- HDL cholesterol (HDL-C) levels > 60 mg/dL lower the risk of cardiovascular complications; alternately, HDL-C levels < 60mg/dL raise the risk of cardiovascular complications
- Non-HDL cholesterol (total cholesterol minus HDL-C; normal is <160mg/dL)
- Normal levels are <150 mg/dL
- > 150 to 499 mg/dL (mild)
- 500-886 mg/dL (moderate)
- >886 mg/dL (severe)
A diagnosis of elevations in LDL-C and triglycerides, and/or a lower-than-normal level of HDL-C, creates high risk for cardiovascular events and such patients are evaluated/treated for other risk factors such as hypertension, hyperglycemia, peripheral artery disease, and other conditions, since these are associated co-morbidities frequently related to abnormal lipid levels. (The diabetic patient at higher risk due to dyslipidemia is evaluated like any high-risk cardiovascular patient, with EKGs, echocardiogram, and stress testing.)