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
...ssessme...
1. Screening and Cardiovascular Disease...
...of Lipids1.1 In adults with endocrine disor...
Table 1. Lipids and Lipoproteins in Select End...
...V Risk Asses...
...n adults with endocrine disorders, we...
...s with endocrine disorders at borderline or...
...t patients with a family history of prematur...
...2. Assessment of ASCVD Risk in Pat...
...ents per 1,000 Person-Years by Strata of CAC...
...able 3. Proposed Decision-Making App...
Hypertriglyceridemia
Hypertriglyceridem...
...pertriglyceridemia...
...dults with fasting TG levels over 500...
...ith triglyceride-induced pancreatitis, we sug...
...patients without diabetes who have TG-indu...
...ho are on statins and still have mode...
2.5 In patients with elevated TG (>150...
Diabetes
Diabetes
.... Type 2 Diabetes Mellitu...
...with T2D and other CV risk factors, we reco...
...adults with T2D and other CV risk f...
...lts with T2D on a statin at LDL goal with residu...
...4 In adults with T2D with chronic kidney disease...
...5 In adults with T2D and diabetic retinopat...
...Type 1 Diabetes Mellitus...
...In adults with type 1 diabetes (T1D) age 40...
...th T1D with CKD in stages 1–4, we sugge...
....3 In adults with T1D with obesity, or with h...
...n adults with T1D and diabetic reti...
Obesity
...besity
...Obesity...
...uals who have obesity, we advise assessment o...
...ividuals who have obesity, we suggest lifest...
...ndividuals who have obesity, we recommend assess...
...duals who have obesity and are on pharmacolo...
...individuals with obesity, (body mas...
Other Conditions
...Conditions...
...yroid Disease...
...ts with hyperlipidemia, we recommend rul...
...ents with hyperthyroidism, we recommend r...
...In patients with overt hypothyroidis...
...4 In patients with subclinical hypothy...
...xcess Glucocorticoids...
...Therapy in Cushing Syndrome...
...s with persistent endogenous Cushing syndrome,...
...ts with cured Cushing syndrome, we advise the a...
...ment in Chronic Glucocorticoid Therapy...
...eceiving chronic glucocorticoid ther...
...Disorders Of Growth Hormone Secr...
...rowth Hormone Deficiency...
8.1 In adults with GHD, we recommend obtaining...
...ith GHD associated with hypopituitarism, w...
...ult patients with GHD, we recommend against...
...th Hormone Excess (Acromegaly)...
...4 In adults with acromegaly, we su...
9. Polycystic Ovary Syn...
...pid Abnormalit...
...In women with polycystic ovary syndrome (...
...ardiovascular...
Effect of treatment of PCOS on lipi...
...enopause And Hormonal Replace...
...In postmenopausal women, we recommend...
...In postmenopausal women on hormone therapy and...
...3 In women who enter menopause early (...
...ism and Testosterone Replacement and Abuse...
...patients with low testosterone levels, we sug...
...1.2 In patients with low HDL (
12. Gender-Affirming Hor...
...In transwomen and transmen who have...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
...ns: LDL-C Reduction by Dose, and Major Drug I...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...5. Medications for Additional LDL-C...