Dyslipidemia

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)

Canadian guidelines recommend Framingham risk
- 10-year Framingham risk of major cardiovascular event
May modify risk based on family history, ethnicity, obesity

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