Lipid Management in Patients with Endocrine Disorders
Key Points
Key Points
- Obtain a lipid panel in adults with endocrine disorders to assess triglyceride (TG) levels and to calculate LDL cholesterol (LDL-C).
- Treat adults with type 2 diabetes (T2D) and other cardiovascular (CV) risk factors with a statin in addition to lifestyle modifications, aiming for an LDL-C goal of <70 mg/dL.
- Consider statin therapy, irrespective of the CV risk score, in adults with type 1 diabetes who are age 40 years and older, or have a history of diabetes of at least 20 years, or either microvascular complications, chronic kidney disease (CKD) stages 1-4, or obesity.
- Rule out hypothyroidism in patients with hyperlipidemia before treatment with lipid lowering medications. In patients with hypothyroidism re-evaluate the lipid profile when the patient is euthyroid.
- Consider statin therapy as adjunct to lifestyle modifications in adults with persistent endogenous Cushing’s syndrome or adults taking chronic glucocorticoid therapy above replacement levels.
- For treatment of dyslipidemia in post-menopausal women, use statins, rather than hormone therapy, because statins reduce atherosclerotic cardiovascular disease (ASCVD).
- Evaluate and treat lipids and other CV risk factors in women who enter menopause early (before the age of 40-45 years).
Assessment
Assessm...
.... Screening and Cardiovascular Disease Risk Ass...
...ment of Lipids1.1 In adults with endoc...
...Lipids and Lipoproteins in Select Endocrine...
CV Risk Asse...
....2 In adults with endocrine disorders, we recom...
1.3 In adults with endocrine disorders at borderli...
...adult patients with a family history o...
.... Assessment of ASCVD Risk in Patients with En...
...D Events per 1,000 Person-Years by S...
...able 3. Proposed Decision-Making Approach...
Hypertriglyceridemia
Hypertriglyceride...
...rtriglyceridemia...
...n adults with fasting TG levels over 500 mg/dL...
...h triglyceride-induced pancreatitis, we suggest ag...
2.3 In patients without diabetes who have TG-ind...
...o are on statins and still have moderately elevate...
...ts with elevated TG (>150 mg/dL to 499 mg/d...
Diabetes
...abetes
...ype 2 Diabetes Mellitus...
...In adults with T2D and other CV risk factors, w...
....2 In adults with T2D and other CV...
...th T2D on a statin at LDL goal with resi...
...ts with T2D with chronic kidney disease stages...
3.5 In adults with T2D and diabetic retinopa...
4. Type 1 Diabetes Mellitu...
...ts with type 1 diabetes (T1D) age 40 ye...
...ults with T1D with CKD in stages 1–4...
...th T1D with obesity, or with high TG and low high...
...lts with T1D and diabetic retinopathy, we s...
Obesity
Obesi...
...Obesit...
...individuals who have obesity, we a...
...als who have obesity, we suggest l...
...als who have obesity, we recommend assessment...
...viduals who have obesity and are on phar...
...individuals with obesity, (body mass index...
Other Conditions
...r Conditions...
...hyroid Disea...
6.1 In patients with hyperlipidemia...
...patients with hyperthyroidism, we r...
...3 In patients with overt hypothyroid...
...In patients with subclinical hypothyroidi...
...ess Glucocorticoids...
...ipid-Lowering Therapy in Cus...
...ith persistent endogenous Cushing syndrom...
...dults with cured Cushing syndrome, we advise the...
...d Management in Chronic Glucocorticoid Thera...
...s receiving chronic glucocorticoid therapy above...
...Disorders Of Growth Hormone Se...
...t Growth Hormone Defi...
8.1 In adults with GHD, we recommend obtaining...
...ts with GHD associated with hypopituitarism,...
...ients with GHD, we recommend against usin...
...wth Hormone Excess (Acromega...
...with acromegaly, we suggest measurement of the...
...Polycystic Ovary Sy...
...d Abnormalities...
...omen with polycystic ovary syndrome (PCO...
...rdiovascular Ri...
...ct of treatment of PCOS on lipids9.2...
...Menopause And Hormonal Replac...
....1 In postmenopausal women, we recommend treating...
...opausal women on hormone therapy and with ot...
...omen who enter menopause early (...
...ogonadism and Testosterone Replaceme...
...ts with low testosterone levels, we suggest te...
....2 In patients with low HDL (
...er-Affirming Hormone Therapy...
...transwomen and transmen who have taken or are tak...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
.... Statins: LDL-C Reduction by Dose, and Major...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...edications for Additional LDL-C Reducti...