Statin therapy for ASCVD prevention: Difference between revisions
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Initial evaluation prior to statin initiation include: | Initial evaluation prior to statin initiation include: | ||
*Fasting lipid panel | *Fasting lipid panel | ||
**Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level | **Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level ≥220 mg/dL could indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are ≥500 mg/dL, a fasting lipid panel is required. | ||
*ALT | *ALT | ||
*CK | *CK | ||
Revision as of 12:38, 28 October 2016
Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Major Recommendations for Statin Therapy for ASCVD Prevention
The following is a treatment algorithm proposed by the AHA/ACC guidelines committee:[1]
Initial evaluation prior to statin initiation
Initial evaluation prior to statin initiation include:
- Fasting lipid panel
- Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level ≥220 mg/dL could indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are ≥500 mg/dL, a fasting lipid panel is required.
- ALT
- CK
- Consider evaluation for other secondary causes
| Secondary Cause | Elevated LDL-C | Elevated Triglycerides |
|---|---|---|
| Diet | Saturated or trans fats
Weight gain Anorexia nervosa |
Weight gain
Very-low-fat diets High intake of refined carbohydrates Excessive alcohol intake |
| Drugs | Diuretics
Cyclosporine Glucocorticoids Amiodarone |
Oral estrogens
Glucocorticoids Bile acid sequestrants Protease inhibitors Retinoic acid Anabolic steroids Sirolimus Raloxifene Tamoxifen Beta blockers |
| Diseases | Biliary obstruction
Nephrotic syndrome |
Nephrotic syndrome
Chronic renal failure Lipodystrophies |
| Disorders and altered states of metabolism | Hypothyroidism
Obesity Pregnancy |
Diabetes (poorly controlled)
Hypothyroidism Obesity Pregnancy |
- ↑ Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH; et al. (2014). "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (25 Suppl 2): S1–S45. doi:10.1161/01.cir.0000437738.63853.7a. PMID 24222016.