Patient-Centered Management of Dyslipidemia: Part 1

Publication Date: April 1, 2016

Key Points

Key Points

  • An elevated level of cholesterol carried by circulating apolipoprotein (apo) B–containing lipoproteins (non-high-density lipoprotein cholesterol [Non-HDL-C] and low-density lipoprotein cholesterol [LDL-C], termed atherogenic cholesterol) is a root cause of atherosclerosis, the key process contributing to most clinical atherosclerotic cardiovascular disease (ASCVD) events.
  • Reducing elevated levels of atherogenic cholesterol will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to result from atherogenic cholesterol lowering through multiple modalities, including lifestyle modification and drug therapies.
  • The intensity of risk-reduction therapy should generally be adjusted to the patient’s absolute risk for an ASCVD event.
  • Atherosclerosis is a process that often begins early in life and progresses for decades before resulting in a clinical ASCVD event. Therefore, both intermediate-term and long-term/lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies.
  • For patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk.
  • Non-lipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus.
  • In all adults (≥20 years of age), a fasting or nonfasting lipoprotein profile should be obtained at least every 5 years.
    • (total-C minus HDL-C). If fasting (generally 9-12 hours), the LDL-C level may be calculated, provided that the triglyceride concentration is <400 mg/dL. (See Table 7)
    • For those with atherogenic cholesterol levels in the desirable range, public health recommendations regarding lifestyle should be emphasized.

Table 1. Criteria for Classification of ASCVD

  • Myocardial infarction or other acute coronary syndrome
  • Coronary or other revascularization procedure
  • Transient ischemic attack
  • Ischemic stroke
  • Atherosclerotic peripheral arterial disease
    • Includes ankle/brachial index <0.90
  • Other documented atherosclerotic diseases such as:
    • Coronary atherosclerosis
    • Renal atherosclerosis
    • Carotid plaque, ≥50% stenosis
    • Aortic aneurysm secondary to atherosclerosis

Risk Assessment

Risk Asses...

...is used both for the purpose of defining trea...


...able 2. Major Risk Factors for ASCVDa...


...Risk CalculatorsHaving trouble vi...


...Criteria for ASCVD Risk Assessment,...


...igh or Very High Risk Patient GroupsHaving tr...


...ble 6. Sequential Steps in ASCVD Risk...


Diagnosis

...agnosi...

...ifications of Cholesterol and Triglyceride Level...


...s That May Elevate LDL-C or Triglyceride Concent...


...ndicators (Other Than Major ASCVD Risk F...


...iet Characteristics and Diseases/Disorde...


Table 11. Criteria for Clinical Id...


Treatment

...atment...

...or patients at low or moderate risk, lifestyle th...


...l of Steps in Lifestyle Therapies...


...ession of Atherogenic-Cholesterol-Lowering Drug...


...tment Goals for Non-HDL-C, LDL-C, and...


...13. Intensity of Statin TherapyaHaving troub...


...LDL ApheresisaHaving trouble viewing table...


...able 15A. Single-Agents — Effects on...


...mbination Drugs — Effects on Lipid Metabolism...


Table 16. Agents for Homozygous Familial Hypercho...