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
...1. Screening and Car...
...easurement of Lipids1.1 In adults with...
Table 1. Lipids and Lipoproteins in Select Endocr...
...CV Ri...
...lts with endocrine disorders, we recomme...
...ts with endocrine disorders at borderline...
....4 In adult patients with a family...
...able 2. Assessment of ASCVD Risk in Patients...
...ure 1. CVD Events per 1,000 Person-Years b...
...e 3. Proposed Decision-Making Approach to Select...
Hypertriglyceridemia
...Hypertriglycer...
...2. Hypert...
....1 In adults with fasting TG level...
...ith triglyceride-induced pancreatitis, w...
...tients without diabetes who have TG-i...
...ts who are on statins and still hav...
...nts with elevated TG (>150 mg/dL to 499 mg/dL [1....
Diabetes
...Di...
...In adults with T2D and other CV risk factors, we...
...dults with T2D and other CV risk factors, we s...
...dults with T2D on a statin at LDL go...
...lts with T2D with chronic kidney disease stage...
...th T2D and diabetic retinopathy, we suggest fibr...
...4. Type 1 Diabetes Mel...
...ith type 1 diabetes (T1D) age 40 yea...
...s with T1D with CKD in stages 1–4,...
4.3 In adults with T1D with obesity, o...
....4 In adults with T1D and diabetic retinopath...
Obesity
...Obesit...
5. Obes...
...dividuals who have obesity, we advise assess...
...ndividuals who have obesity, we suggest...
...als who have obesity, we recommend a...
...individuals who have obesity and are on phar...
...uals with obesity, (body mass index >40 o...
Other Conditions
...Other Conditions...
...6. Thyroid Diseas...
...ts with hyperlipidemia, we recommen...
6.2 In patients with hyperthyroidism,...
...nts with overt hypothyroidism, we suggest again...
....4 In patients with subclinical hypoth...
...7. Excess Glucocortico...
...Lipid...
...n adults with persistent endogenous Cushing syndr...
...n adults with cured Cushing syndrome, we adv...
...Lipid M...
...ults receiving chronic glucocorticoid therapy...
...8. Disorders Of Growth Ho...
...Adult Growth H...
8.1 In adults with GHD, we recommend obtai...
...n adults with GHD associated with hypopituita...
...adult patients with GHD, we recommend aga...
...Growth Hormone E...
...4 In adults with acromegaly, we suggest mea...
...Lipid Abnormalities...
...n with polycystic ovary syndrome (PCOS), we rec...
...Cardiovascular Risk...
...ment of PCOS on lipids9.2 In women with PCO...
...10. Menopause And Ho...
...nopausal women, we recommend treating dysli...
...2 In postmenopausal women on hormo...
...In women who enter menopause earl...
....1 In patients with low testosterone lev...
...n patients with low HDL (...
...12. Gender-...
...In transwomen and transmen who have taken or...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
...tatins: LDL-C Reduction by Dose, an...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...5. Medications for Additional LDL-C Reduction in...