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
...essment...
1. Screening and Cardiovascular Disease Risk Asses...
Measurement of Lipids1.1 In adults with endocri...
...and Lipoproteins in Select Endocrin...
...Risk Assessm...
....2 In adults with endocrine disorders...
...with endocrine disorders at borderline o...
1.4 In adult patients with a family...
...ble 2. Assessment of ASCVD Risk in Patien...
...Events per 1,000 Person-Years by Strata o...
...sed Decision-Making Approach to Selective Use of...
Hypertriglyceridemia
...ypertriglyceride...
...pertriglyceridemia
...In adults with fasting TG levels over 500...
...with triglyceride-induced pancreat...
...3 In patients without diabetes who have TG-indu...
...o are on statins and still have moderately eleva...
...atients with elevated TG (>150 mg/dL to 49...
Diabetes
...iabete...
...e 2 Diabetes Mellitus...
...s with T2D and other CV risk factors, w...
...with T2D and other CV risk factors, we s...
...dults with T2D on a statin at LDL goal w...
...ults with T2D with chronic kidney disease stage...
...In adults with T2D and diabetic ret...
...ype 1 Diabetes Mellit...
...lts with type 1 diabetes (T1D) age 4...
...s with T1D with CKD in stages 1–4, we s...
...n adults with T1D with obesity, or w...
4.4 In adults with T1D and diabetic re...
Obesity
...besity...
5. Obesit...
...ls who have obesity, we advise ass...
...individuals who have obesity, we suggest li...
...uals who have obesity, we recommend ass...
...uals who have obesity and are on pharmacol...
...n individuals with obesity, (body mass inde...
Other Conditions
...ther Conditions...
...roid Disease...
...In patients with hyperlipidemia, we recommend ru...
...tients with hyperthyroidism, we re...
...ients with overt hypothyroidism, we s...
...with subclinical hypothyroidism (thyroi...
...Excess Glucocorticoi...
...-Lowering Therapy in Cushing Syndrome...
...ts with persistent endogenous Cushing syndro...
...adults with cured Cushing syndrome, w...
...in Chronic Glucocorticoid Therapy...
...4 In adults receiving chronic glucocorticoid...
...rs Of Growth Hormone Secretion...
...owth Hormone Deficiency...
...dults with GHD, we recommend obtaining a lip...
....2 In adults with GHD associated with hypopi...
...atients with GHD, we recommend against us...
...rowth Hormone Excess (Ac...
...In adults with acromegaly, we sug...
...cystic Ovary Syndrome
...Abnormalities...
...women with polycystic ovary syndrome (PCOS), we...
...iovascular Risk
...treatment of PCOS on lipids9.2 In women wi...
...e And Hormonal Replacement...
...0.1 In postmenopausal women, we recommend treatin...
...pausal women on hormone therapy and with o...
...who enter menopause early (...
...ypogonadism and Testosterone Replacement and A...
....1 In patients with low testosteron...
...tients with low HDL (...
12. Gender-Affirming Hormon...
...In transwomen and transmen who have...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
...Statins: LDL-C Reduction by Dose, and Major Drug...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...le 5. Medications for Additional LDL-C Re...