Dyslipidemia Fall 2012 (1)

Patients with chd mi angina cardiac surgery chd risk

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Patients with CHD:   MI, angina, cardiac surgery CHD risk equivalent: Non-coronary atherosclerotic vascular disease Abdominal aortic aneurism (AAA) Peripheral arterial disease (PAD) Diabetes Patients with  ≥ 2 risk factors  and a 10-year  Framingham risk score > 20% Risk categories
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Risk categories Very high risk   No Framingham risk score needed Established CVD and 1 of the following  criteria Multiple major risk factors (especially diabetes) Severe and poorly controlled risk factors  (especially smoking) Multiple risk factors for metabolic syndrome  Acute coronary syndromes (ex: acute MI)
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Patient Specific Assessment Assess patient specific CVD risk Determine therapy target (s) Evaluate modifiable risk factors Rule out secondary causes of  dyslipidemia
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Primary Target: LDL Goals Risk Category LDL-C Goal  (mg/dL) Initiate TLC  (mg/dL) High risk <100 (optional <70) ≥ 100 Moderately high risk < 130 (optional < 100) ≥ 130 Moderate risk < 130 ≥ 130 Lower risk < 160 ≥ 160 National Cholesterol Education Program’s Expert Panel on Detection, Evaluation, and Treatment of High  Blood Cholesterol in Adults, Adult Treatment Panel III. NCEP ATP III Update. Circulation. 2004.
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Primary Target: Triglyceride Goal When TG are very high:  ≥ 500 mg/dL LDL-C is no longer the primary target Immediate goal:     TGs and   risk of further TG elevation When TG > 1000 mg/dL   at increased risk of pancreatitis Very low fat diet:  <15% of total daily calories Once TGs are < 500 mg/dL then evaluate if LDL-C is at  goal
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Additional Targets of Therapy Secondary target:    Non-HDL-C Goal, when applicable, is always 30 mg/dL higher  than the LDL-C goal Tertiary target:    HDL-C Goal, when applicable, is > 40 mg/dL in men and >  50 mg/dL in women Optional goals represent an aggressive  approach that maximally reduces CV risk
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Patient Specific Assessment Assess patient specific CVD risk Determine therapy target (s) Evaluate modifiable risk factors Rule out secondary causes of  dyslipidemia
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Modifiable Risk Factors Genetics Physical inactivity Dietary Smoking Excess alcohol intake Diabetes mellitus Hypothyroidism Kidney disease
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Patient Specific Assessment Assess patient specific CVD risk Determine therapy target (s) Evaluate modifiable risk factors Rule out secondary causes of  dyslipidemia
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Disorders of Lipoproteins: Secondary Dyslipidemia Lipoprotein Cause  LDL-C  TG  HDL-C Diseases Hypothyroidism Nephrotic  syndrome Obstructive liver  disease Alcoholism Diabetes mellitus Hypothyroidism Diabetes mellitus Hyperthyroidism
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Patients with CHD MI angina cardiac surgery CHD risk...

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