Patient-Centered Management of Dyslipidemia: Part 2
Chart 1. Nutritional Recommendations
Chart 2. Exercise/Physical Activity Recommendations
Chart 3. Patient Adherence
- simplify the regimen
- provide clear education using visual aids and simple, low-literacy educational materials
- engage patients in decision-making, addressing their specific needs, values, and concerns
- address perceived barriers of taking medication
- identify suboptimal health literacy and use “teach-back” techniques to increase patient understanding of those behaviors needed to be successful
- screen and eliminate drug-drug and drug-disease interactions leading to low adherence or drug discontinuation
- praise and reward successful behaviors.
Chart 4. Team-Based Collaborative Care
- Currently, TG is not a specific target for therapy except when levels are ≥500 mg/dL.
- When the TG concentration is ≥500 mg/dL, and especially if ≥1000 mg/dL, reducing risk of pancreatitis by lowering of TG to <500 mg/dL becomes the primary goal of therapy.
- Presently, prescription EPA and EPA + DHA concentrates, which have been approved in ethyl ester and carboxylic acid forms, are indicated for the treatment of very high TG (≥500 mg/dL).
- Fibrate drugs can reduce TG and non-HDL -C in patients with mixed dyslipidemia, and are considered a first-line choice for patients with severe hypertriglyceridemia (TG ≥500 mg/dL).
Chart 5. Children and Adolescents
- One or both biological parents are known to have hypercholesterolemia or are receiving lipid- lowering medications
- Have a family history of premature ASCVD in an expanded first degree pedigree (i.e., to include not only parents and siblings, but also aunts, uncles, and grandparents) in men <55 or women <65 years of age
- Consideration should also be given to screening for those in whom family history is unknown (e.g., adopted)
- Non-HDL-C: 144 mg/dL
- LDL- C: 129 mg/dL
The following treatment plans can be considered: ( B , Moderate )
- Administer pharmacologic agents, primarily statins, when LDL-C level is ≥190 mg/dL and/or non- HDL-C is ≥220 mg/dL.
- Consider additional risk factors in addition to elevated LDL-C and/or non-HDL-CCCC and follow the treatment algorithm from the 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: National Heart, Lung, and Blood Institute.
Chart 6. Women's Health
Chart 7. Pregnancy to Menopause
Chart 8. Older Patients
Chart 9. Hispanics/Latinos
Hispanics/Latinos tend to have a greater prevalence of high TG and low HDL-CHispanics/Latinos tend to have a greater prevalence of high TG and low HDL-CHispanics/Latinos tend to have a greater prevalence of high TG and low HDL-CHispanics/Latinos tend to have a greater prevalence of high TG and low HDL-CHispanics/Latinos tend to have a greater prevalence of high TG and low HDL-C than NHWs, leading to higher levels of non-HDL-C, and an increased likelihood for discordance between LDL-C and non-HDL-C concentrations. LDL-C levels tend to be higher in Hispanic men compared with NHW men.( A , Moderate )
Chart 10. African Americans (AAs)
Chart 11. South Asians (SAs)
Chart 12. American Indians/Alaska Natives (AIs/ANs)
Chart 13. HIV-Infected Persons
Chart 14. Patients with Rheumatoid Arthritis (RA)
Residual Risk After Statins and Lifestyle Modification
Table 14. Recommendations
- First – ezetimibe 10 mg every day
- Second – colesevelam 625 mg 3 tablets twice a day
(or 3.75 g powder form every day or in divided doses)
- Third – extended release niacin titrated to a maximum of
2000 mg daily.
- patients with ASCVD who have LDL-C ≥100 mg/dL (non-HDL-C ≥130 mg/dL) while on maximally-tolerated statin (±ezetimibe) therapy and
- heterozygous FH patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C patients without ASCVD who have LDL- C who have LDL- C who have LDL- C ≥130 mg/dL (non-HDL-C ≥160 mg/dL) while on maximally-tolerated statin (±ezetimibe) therapy.
[non-HDL-C ≥100 mg/dL]). Such use would be based on clinical judgment, weighing the potential benefits relative to the ASCVD event risk and the risks and costs of therapy. ( C , Low )
Patient-Centered Management of Dyslipidemia: Part 2
December 1, 2015
Supplemental Implementation Tools
External Publication Status
Country of Publication
It provides recommendations regarding the following topics: (1) lifestyle therapies; (2) groups with special considerations, including children and adolescents, women, older patients, certain ethnic and racial groups, patients infected with human immunodeficiency virus, patients with rheumatoid arthritis, and patients with residual risk despite statin and lifestyle therapies; and (3) strategies to improve patient outcomes by increasing adherence and using team-based collaborative care.
Target Patient Population
Patients with dyslipidemia
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Nurse, nurse practitioner, physician, physician assistant
Assessment and screening, Management, Treatment
D050171 - Dyslipidemias, D000070497 - Healthy Lifestyle, D010348 - Patient Care Team
cardiovascular team-based care, dyslipidemia, comprehensive lifestyle intervention