Lipid Management in Patients with Endocrine Disorders

Publication Date: September 19, 2020

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...

...Screening and Cardiovascular Disease Risk...

...ement of Lipids1.1 In adults with endoc...

...Lipids and Lipoproteins in Select...

...Risk Assessment...

...ts with endocrine disorders, we recommend cond...

...adults with endocrine disorders at border...

...adult patients with a family history of prematu...

...ent of ASCVD Risk in Patients with En...

...vents per 1,000 Person-Years by Strat...

...osed Decision-Making Approach to Selective U...


Hypertriglyceridemia

...ypertriglyceridemia...

...ertriglyceridemia

...adults with fasting TG levels over 500 mg/d...

...atients with triglyceride-induced pancreatitis,...

2.3 In patients without diabetes who have T...

...who are on statins and still have mode...

...atients with elevated TG (>150 mg/dL...


Diabetes

...abetes

...e 2 Diabetes Mellitus...

....1 In adults with T2D and other CV risk facto...

...lts with T2D and other CV risk fac...

...In adults with T2D on a statin at LD...

3.4 In adults with T2D with chronic...

...5 In adults with T2D and diabetic retinop...


...Type 1 Diabetes Melli...

...ith type 1 diabetes (T1D) age 40 years a...

...ith T1D with CKD in stages 1–4, we suggest s...

...n adults with T1D with obesity, or...

...with T1D and diabetic retinopathy,...


Obesity

...esity...

...Obesity...

...iduals who have obesity, we advise assess...

...uals who have obesity, we suggest lifestyle me...

...individuals who have obesity, we recommend asses...

...als who have obesity and are on pharmacol...

...In individuals with obesity, (body mass...


Other Conditions

...her Conditi...

...Thyroid Disease...

...1 In patients with hyperlipidemia, we...

...patients with hyperthyroidism, we recommend re-ev...

...with overt hypothyroidism, we suggest against...

...patients with subclinical hypothyroidis...


7. Excess Glucocorticoid...

...Therapy in Cushing Syndrome

...ith persistent endogenous Cushing syndrome, we sug...

...s with cured Cushing syndrome, we advise the appro...

...ent in Chronic Glucocorticoid Therapy...

...receiving chronic glucocorticoid ther...


...sorders Of Growth Hormone Secr...

...owth Hormone Deficiency...

...ith GHD, we recommend obtaining a lipid pr...

...n adults with GHD associated with hypopituitarism,...

...3 In adult patients with GHD, we recommend a...

Growth Hormone Excess (Acromeg...

...adults with acromegaly, we suggest measureme...


.... Polycystic Ovary Synd...

...Abnormalities...

...In women with polycystic ovary syndrome (PCOS), w...

...vascular Risk

...treatment of PCOS on lipids9.2 In women...


...pause And Hormonal Replacemen...

10.1 In postmenopausal women, we recommend treat...

...2 In postmenopausal women on hormone therap...

...In women who enter menopause early...


...and Testosterone Replacement and A...

...tients with low testosterone levels, we suggest te...

...patients with low HDL (...


...er-Affirming Hormone Therapy...

...men and transmen who have taken or are taking gend...


Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions

...s: LDL-C Reduction by Dose, and Majo...

Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)

...Medications for Additional LDL-C Reduction in...