Guidelines for management of dyslipidemia emphasize the importance of weight management, dietary choices, and exercise. TLC or Therapeutic Life Style Therapies for primary prevention of CVD include all of the following except:
Omega-3 polyunsaturated fatty acid supplements of 800 to 1,000 mg a day. Diets high in omega-3 saturated fat are recommended but universal use of supplements is not. The AHA recommends 800 to 1,000 mg/day in dietary consumption and to consider supplements in secondary prevention patients without an adequate dietary source. Omega-3 fatty acids have a role in managing high TGs (>500 mg/day) by using high doses of prescription or supplement forms at 2,000 to 4,000 mg/day. Long-term outcome data supporting definitive reduction in CVD events with omega-3 supplementation in primary prevention populations are lacking. All of the other recommendations listed are supported by the guidelines.
Secondary causes of dyslipidemia include all EXCEPT which of the following?
Hyperthyroidism. Identifying and treatment of or modifying secondary causes of dyslipidemia is an important component in the management of dyslipidemia. Treating hypothyroidism and better control of diabetes may have significant impact on correcting lipid abnormalities. If possible, identification of medications associated with dyslipidemia and substitution of alternate medications when possible may help. Cholesterol and TGs rise progressively throughout pregnancy. Drugs such as statins, niacin, and ezetimibe are contraindicated during pregnancy and lactation.
According to NCEP ATP III, CHD risk equivalent defines high-risk individuals who would benefit from more intensive lipid-modifying therapies and include individuals with all of the following except:
FRS indicating a 10-year risk of MI or coronary death of >10%. Any clinically significant non-coronary vascular diseases such as peripheral artery disease, carotid artery disease, and aortic disease would qualify. Diabetics also fall into this category, particularly those >40 years of age and with at least one additional CVD risk factor. CHD risk equivalent status is present in individuals without clinically evident CHD, other CVD, or diabetes but with two or more CVD risk factors and FRS associated with a 10-year risk of a fatal or nonfatal MI of >20% not >10%. All of these individuals would be candidates for aggressive lipid management. The NCEP ATP III guidelines recommend LDL-C goals <100 mg/dL and optional LDL-C goals <70 mg/dL in this group. The ACC/AHA 2013 hyperlipidemia guidelines have eliminated LDL-C goals for therapy and recommend high-intensity statin therapy to achieve LDL-C lowering of >50% in high-risk groups <75 years old. This includes individuals with coronary and non- coronary disease, diabetics with new Pooled Cohort Equation calculator risk of >7.5% 10-year risk.
You see a 52-year-old man with a history of type 2 DM on metformin. He has a history of hypertension controlled on amlodipine and an angiotensin-converting enzyme inhibitor. His BMI is 31.7 and waste circumference is 41 inches. His father had a coronary stent at the age of 54. He has the following fasting laboratory values:
Based on NCEP ATP III and American Diabetes Association (ADA) guidelines, the most appropriate lipid goals for therapy in this patient are:
LDL <70 mg/dL and non-HDL <100.
Additional secondary goals for therapy in this patient based on NCEP ATP III and American Diabetes Association (ADA) guidelines include:
apoB <80 mg/dL and LDL-P <1,000
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