Management of Dyslipidemia for Cardiovascular Risk Reduction (Lipids)

Publication Date: June 1, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the Department of Veterans Affairs, the Department of Defense, for the management of dyslipidemia for cardiovascular risk reduction. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Dyslipidemias are disorders of lipids (fats) in the blood that can promote atherosclerosis (heart and blood vessel disease).
    • There are three types of fats involved:
      • Low-density Lipoprotein-cholesterol (LDL-C), that encourage the development of atherosclerosis. (The “C” stands for cholesterol.)
      • High-density Lipoprotein-cholesterol (HDL-C), that protect against atherosclerosis
      • Triglycerides, that encourage the development of atherosclerosis and can also cause pancreatic inflammation at high levels.
  • Dyslipidemias are primarily due to the way your body chemistry works, which is controlled by your genes.
    • But it can be influenced by diet, alcohol and diseases like diabetes.
  • Dyslipidemias cause no symptoms.
  • This patient summary focuses on identifying and preventing problems due to dyslipidemias.

Screening and Diagnosis

Screening and Diagnosis

  • The VA suggests blood test screening for dyslipidemias at intervals no less than 10 years.
  • The VA suggests using a 10-year heart disease risk calculator.

Prevention and Treatment

Prevention and Treatment

  • A Mediterranean diet.
  • Regular contact with your doctor
  • For primary prevention (before the disease develops):
    • A low-dose statin if LDL-C is over 190 mg/dL or 10-year risk is over 12%
    • Possibly a moderate-dose statin if the 10-year risk is 6%–12% and you approve
  • For secondary prevention (after the disease develops):
    • A statin and possibly ezetimibe or a PCSK9 inhibitor as you choose after a discussion of risks and benefits with your doctor
    • An exercise-based heart rehabilitation program
  • There are other options available for elevated triglycerides and if any of these regimens do not prove optimal.

Abbreviations

  • HDL-C: High-density Lipoprotein-cholesterol
  • LDL-C: Low-density Lipoprotein-cholesterol
  • PCSK9: Proprotein Convertase Subtilisin/kexin Type 9
  • VA: Veterans Administration

Source Citation

O'Malley PG, Arnold MJ, Kelley C, Spacek L, Buelt A, Natarajan S, Donahue MP, Vagichev E, Ballard-Hernandez J, Logan A, Thomas L, Ritter J, Neubauer BE, Downs JR. Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2020 Nov 17;173(10):822-829. doi: 10.7326/M20-4648. Epub 2020 Sep 22. PMID: 32956597.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.