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Management of Dyslipidemia and The Prevention of Cardiovascular Disease
Management of Dyslipidemia and The Prevention of Cardiovascular Disease
OF CARDIOVASCULAR DISEASE
Summary of the “Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: 2003 update.”
• Routinely screen men over age 40 and women who are postmenopausal or over age 50.
Note: Although there are no evidence-based recommendations regarding the optimal frequency for
screening, it is reasonable to suggest asymptomatic patients with previously normal lipids be screened
every 5 years after age 40 (men) or 50 (women).
• Screen those with diabetes mellitus; risk factors such as hypertension, smoking or abdominal obesity; a strong
family history of premature cardiovascular disease; manifestations of hyperlipidemia; or evidence of symptomatic
or asymptomatic atherosclerosis.
• Patients of any age may be screened at the discretion of the physician, particularly when lifestyle changes are
indicated.
Table 1 Table 2
Risk Categories and Target Lipid Levels Clinical Identification of the
Metabolic Syndrome*
RISK CATEGORY TARGET LEVEL
LDL-C level Total cholesterol • The clustering of cardiovascular risk factors is recognized as
mmol/L HDL-C ratio being an important health issue.
High <2.5 and <4.0 • The metabolic syndrome is defined in qualitative terms and
(10 year risk of coronary encompasses abdominal obesity, insulin resistance, elevated
artery disease ≥ 20%, or plasma triglyceride levels, low HDL-C levels and high blood
history of diabetes mellitus; pressure.
any atherosclerotic disease Risk factor Defining level
including CAD, PAD, CVD;
Abdominal obesity
chronic kidney disease or
Men Waist circumference > 102cm (40in)
those undergoing long term
dialysis) Women Waist circumference > 88cm (35in)
Alberta
Drug
For complete guideline: http://www.cmaj.ca/cgi/reprint/169/9/921
Utilization
Program
References available upon request.
www.topalbertadoctors.org
TREATMENT
• Diet: An important focus should be on decreasing energy consumption, in particular by reducing intake of refined
carbohydratesand sugar to achieve and maintain a body mass index of less than 25 kg/m2.
• Exercise: Recommend at least 30 minutes of physical activity (such as walking) per day, most days of the week.
• Medication:
- In people at high risk of coronary artery disease, treatment should be started immediately, concomitant with
diet and therapeutic lifestyle changes.
- For patients at low and moderate risk, pharmacological treatment should be initiated if target lipid levels
(Table 1) are not met after 3 and 6 months respectively, of lifestyle therapy.
Lipid Lowering Medications:
Relative Lipid Lowering Effects Drugs of Choice for Management
Drug LDL-C HDL-C Triglycerides Lipid Profile 1st Choice 2nd Choice
5 mg 40 mg 20 mg 20 mg 2.5 mg 10 mg
MONITORING
• Lipid Levels
- It is generally recommended that lipid levels be rechecked 4 - 6 weeks after the commencement of therapy.
- Treatment goal reached: recheck lipid profile every 6 - 12 months depending on the risk profile of the patient.
- Treatment goal not reached: recheck lipid profile 4 - 6 weeks after each dosage change.
• CK and ALT
- Baseline CK and ALT levels (prior to initiating drug therapy) should be obtained.
- It is generally recommended that CK and ALT levels be rechecked 4 to 6 weeks after the commencement
of therapy.
- After 6 weeks, routine monitoring of CK and ALT may not be required in patients receiving statin therapy.
- Patients with unexplained symptoms of weakness, muscle aches, and soreness should have statin therapy
stopped and prompt laboratory investigation of CK and ALT.
- With a CK level between 5 - 10 times the upper limit of normal (ULN), clinical judgement should dictate
whether to continue therapy or not. If CK is elevated greater than 10 times ULN in a symptomatic patient
then the drug should be discontinued.
- For patients receiving a statin with an interacting medication it may be prudent to monitor CK every 6 months
due to the increased risk of myopathy.
- Inform patients of possible side-effects of medications (e.g., myalgia with statins) and when to contact
prescribing doctor.