|
Treating Dyslipidemia
Sources: National Cholesterol Education Program. Third Report of The Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults.(Adult Treatment Panel III) 2001 and also Implications of Recent Trials for the National Cholesterol Educational Program Adult Treatment Panel III guidelines (Circulation 2004).
Identify presence of any of the following:
-
Coronary Heart Disease (CHD)
-
CHD risk equivalents: Symptomatic Carotid Artery Disease; Peripheral
Artery Disease; Cerebrovascular Disease; Abdominal Aortic Aneurysm;
Diabetes Mellitus
-
Cigarette smoking - any amount
-
Hypertension - blood pressure>140/90 or on anti- hypertensive medication
-
Low levels of HDL - cholesterol - < 40 mg/dl
-
A family history of premature coronary artery disease- in a first degree
male relative <age 55; female relative<age 65
-
Advancing age- >=45 for males; >=55 for females
LDL-cholesterol goals and cut-points for Therapeutic Lifestyle Changes (TLC) and drug therapy in different risk categories.
|
Risk
category
|
Ldl goal
|
Ldl
level at which to initiate therapeutic lifestyle changes (TLC)
|
Ldl
level at which to consider drug therapy
|
Comments |
|
CHD or CHD
risk equivalents (10-year risk >20%)
|
<100 mg/dl
optional<70mg/dl |
100 mg/dl
|
100 mg/dl
<100mg/dl: consider drug options
|
Statins –
drug of choice for lowering cholesterol levels
|
|
2+ risk
factors (10-year risk 10- 20%)
|
<130 mg/dl
optional<100mg/dl |
≥130
mg/dl |
≥130
mg/dl
(100-129mg/dl: consider drug options) |
For
calculating ten-year risk, see Heart Disease Risk |
|
2+ risk
factors (10-year risk<10%)
|
<130 mg/dl |
≥130
mg/dl |
>160mg/dl |
|
|
0-1 risk
factor*
|
<160 mg/dl
|
≥160
mg/dl
|
190 mg/dl
(160-189 mg/dl: Ldl-lowering drug optional)
|
|
* Almost all people with 0-1 risk factors have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factors is not necessary.
Therapeutic Lifestyle Changes
(TLC)
|
TLC
Diet: Saturated fat<7% of calories, cholesterol < 200mg/dl. Consider
viscous soluble fiber (10-25 g/day) and plant stanols/sterols (2g/day) as
therapeutic options to enhance LDL lowering.
Weight Management
Increased Physical Activity | Identify And Treat
|
Metabolic Syndrome
Hypertrygliceridemia
Low Hdl-Cholesterol Levels | |