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
...Assessment...
...surement of Lipids1.1 In adults with e...
...ids and Lipoproteins in Select Endocrine Disorders...
...CV Risk Assessment...
...ults with endocrine disorders, we recommend cond...
...ith endocrine disorders at borderlin...
1.4 In adult patients with a family...
...le 2. Assessment of ASCVD Risk in Pa...
...D Events per 1,000 Person-Years by Strata of CAC...
...ble 3. Proposed Decision-Making Approach to...
Hypertriglyceridemia
...Hypertriglycerid...
...2. Hype...
2.1 In adults with fasting TG levels over...
...patients with triglyceride-induced pan...
...ts without diabetes who have TG-ind...
...lts who are on statins and still hav...
...ients with elevated TG (>150 mg/dL to 499 mg/d...
Diabetes
...Diabetes...
...3. Type 2 Diabe...
...with T2D and other CV risk factors...
...s with T2D and other CV risk factor...
...lts with T2D on a statin at LDL goal with resid...
....4 In adults with T2D with chronic kidney diseas...
...dults with T2D and diabetic retinopathy, we...
...4. Type 1 Diabetes M...
...with type 1 diabetes (T1D) age 40 ye...
4.2 In adults with T1D with CKD in st...
...ith T1D with obesity, or with high TG...
...th T1D and diabetic retinopathy, we sug...
Obesity
...Obesity...
...5. Obesity...
...ividuals who have obesity, we advise asse...
...iduals who have obesity, we suggest...
...individuals who have obesity, we reco...
...ls who have obesity and are on pharmacological t...
...viduals with obesity, (body mass index >40 or >35...
Other Conditions
...Other Condition...
...6. Thyroid...
...with hyperlipidemia, we recommend...
...with hyperthyroidism, we recommend re-evaluating...
...In patients with overt hypothyroidism,...
...tients with subclinical hypothyroidism...
...7. Excess Glucocorticoids...
...Lipid-Lower...
...2 In adults with persistent endogenous Cushing s...
7.3 In adults with cured Cushing sy...
...Lipid Management in Chr...
...In adults receiving chronic glucocorticoid...
...8. Disorders Of Growth Hormo...
...Adult Growth Hormone D...
...ts with GHD, we recommend obtaining a lipi...
...In adults with GHD associated with hypopituitaris...
...3 In adult patients with GHD, we recommend...
...n adults with acromegaly, we suggest...
...9. Polycystic Ovary Sy...
...Lipid Abnormalitie...
...h polycystic ovary syndrome (PCOS)...
...Cardiova...
...atment of PCOS on lipids9.2 In women...
...10. Menopause And...
...stmenopausal women, we recommend treating d...
...postmenopausal women on hormone therapy and with...
...women who enter menopause early (...
11. Hyp...
...ts with low testosterone levels, we suggest t...
...In patients with low HDL (...
...12. Gender-Affi...
...In transwomen and transmen who have ta...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
...: LDL-C Reduction by Dose, and Major Drug...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...5. Medications for Additional LDL-...