Dyslipidemia Treatment
-
Primary prevention of Dyslipidemia
- People Without CHD
- Preventing first event
- Is beneficial for reducing CV morbidity and mortality
-
Secondary prevention of Dyslipidemia
- People with history of ASCVD.
- Trials have shown the largest benefit in mortality and CV events.
-
Lipid Lowering Medications
When to Refer?
-
TG >20mmol/L ➔ refer urgently (if not a result of excess alcohol or poor glycemic control).
-
If between 10 and 20 ➔ repeat fasting after 5 days = consult if it remains >10
-
Familial hypercholesterolemia: (First exclude: excessive alcohol, poorly controlled diabetes, hypothyroidism, liver disease/nephrotic syndrome)
- ➢ T. cholesterol >7.5 + a family history of premature heart disease
- ➢ T. cholesterol >9.0mmol/L
- ➢ non-HDL cholesterol >7.5mmol/L (or LDL >13 in adult, or 11 in children)
- ➢ Xanthomata & Arcus
-
In high risk patients who are intolerant of 3 different statins, obtain specialist advice
-
Seek specialist advice if non-HDL cholesterol concentration is >7.5 mmol/L
Why Treat Dyslipidemia?
- Major modifiable risk factor for ASCVD
(Cardiovascular disease (CVD) has been recognized as the number one killer in the world for decades.)
Evidence that serum cholesterol contributes to ASCVD comes from several sources:
- Animal studies,
- Genetic forms of hypercholesterolemia,
- Epidemiological studies, and
- RCTs.
- Multiple evidence supports the use of statins in prevention of ASCVD.
Dyslipidemia Management Guidelines
Guidelines / Viewpoints to Consider:
- NICE National Institute for Health and Care Excellence
- American Diabetes Association
- DiabetesPro
- American College of Cardiology
- American Heart Association
- AACE American Association of Clinical Endocrinology
- NIH National Heart, Lung, and Blood Institute
DYSLIPIDEMIA
CLINICAL PRACTICE GUIDELINES
but they are some common themes that you will see and there are some common patients that all these guidelines feel that would benefit from treatment , specifically statin statin benefit group along the way
Statin Benefit Group
-
Clinical ASCVD - High intesity - except over 75 years age due side effects of rhabdomyolysis
-
LDL-C
- ≥190 mg/dL
-
Diabetes - moderate intensity - if 7.5 gives high
- LDL-C 70–189 mg/dL
- Age 40–75 y
-
≥7.5% estimated 10-y ASCVD risk and age 40–75 y - moderate intesity
— its going to be our job to recognize which patientsare going to be treated with lifestyle vs which patient are going to be treated with lifestyle plus statin — so at the end of the day if its Statin benefit group ( independent of what lipid profile they give you Low HDL of hight Tag) u r going to give statin no other first line treatment on board.
*4 major statin benefit groups: * Focus on ASCVD Risk Reduction: 4 Statin Benefit Groups This guideline is based on a comprehensive set of data from RCTs from which 4 statin benefit groups were identified that focus efforts to reduce ASCVD events in secondary and primary prevention. This guideline identifies high-intensity and moderate-intensity statin therapy for use ina secondary and primary prevention.