Dyslipidemia
From IDWiki
Screening
- Screen men ≥40, women ≥40 or postmenospausal women
- Regardless of age
- Clinical evidence of atherosclerosis
- Abdominal aortic aneurysm (AAA)
- Diabetes mellitus
- Hypertension
- Smoking
- Clinical signs dyslipidemia
- Family history of early CVD
- Family history of dyslipidemia
- CKD
- Obesity
- IBD
- HIV
- Erectile dysfunction
- COPD
- HTN in pregnancy
- Screen with
- H&P
- Lipid panel (TC< LDL-C, HDL-C, TG)
- Can be non-fasting
- Non-HDL-C (calculated from above)
- Glucose
- eGFR
- Optional screening tests
- ApoB
- Urine albumin:creatinine ratio (if CKD, HTN, or DM)
Cardiovascular Risk Assessment
- Canadian guidelines recommend Framingham risk
- 10-year Framingham risk of major cardiovascular event
- May modify risk based on family history, ethnicity, obesity
Management
- Diet
- Mediterranean diet (nuts or olive oil)
- Portfolio diet reduces LDL-C
- Nuts ≥30 g/d
- Soy protein ≥30g/d
- Plant sterols/stanols ≥2 g/d
- Soluble fibre ≥10 g/d
- Statins for primary prevention
- No need to treat for low-risk individuals FRS <10%
- Statin for high-risk individuals FRS >20%
- Statin for intermediate-risk individuals who have
- LDL-C ≥3.5, or
- LDL-C <3.5 but apoB ≥1.2 or non-HDL ≥4.3, or
- Men ≥50 years or women ≥60 years and 1 other CV risk factor
- Every 1 mmol/l reduction in LDL-C is associated with a 20-25% reduction in cardiovascular events
- Treat to target with Canadian guidelines
- 50% reduction from baseline LDL-C or decrease to <2 mmol/l
- Can consider apoB <0.8 g/l or non-HDL-C <2.6 mmol/L as alternative targets
- Secondary prevention
- Add ezetimibe if still not at target
- PCSK-9 inhibitors are a new avenue of treatment
- Evolocumab and alirocumab
- Decreases cardiovascular events
