Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management: Difference between revisions

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/* ACC / AHA Guidelines - Lipid Management(DO NOT EDIT) {{cite journal |author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS...
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{{cquote|   
{{cquote|   
===Class I===
===[[ACC AHA guidelines classification scheme#Classification of Recommendation|Class I]]===


'''1.''' The following lipid recommendations are beneficial:
'''1.''' The following lipid recommendations are beneficial:
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::'''b.''' If [[triglyceride]]s are ≥500 mg/dL, therapeutic options to prevent [[pancreatitis]] are [[fibrate]] or [[niacin]] before [[LDL]]-lowering therapy is recommended. It is also recommended that [[LDL-C]] be treated to goal after [[triglyceride]] lowering therapy. Achievement of a [[non HDL-C]] <130 mg/dL (i.e., 30 mg/dL greater than [[LDL-C]] target) if possible is recommended. ''(Level of Evidence: C)''
::'''b.''' If [[triglyceride]]s are ≥500 mg/dL, therapeutic options to prevent [[pancreatitis]] are [[fibrate]] or [[niacin]] before [[LDL]]-lowering therapy is recommended. It is also recommended that [[LDL-C]] be treated to goal after [[triglyceride]] lowering therapy. Achievement of a [[non HDL-C]] <130 mg/dL (i.e., 30 mg/dL greater than [[LDL-C]] target) if possible is recommended. ''(Level of Evidence: C)''


===Class IIa===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===


'''1.''' The following lipid management strategies can be beneficial:
'''1.''' The following lipid management strategies can be beneficial:
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::'''g.''' The addition of plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) is reasonable to further lower [[LDL-C]]. ''(Level of Evidence: A)''
::'''g.''' The addition of plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) is reasonable to further lower [[LDL-C]]. ''(Level of Evidence: A)''


===Class IIb===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===


'''1.''' Encouraging consumption of [[omega-3 fatty acids]] in the form of fish or in capsule form (1 g per d) for risk reduction may be reasonable. For treatment of elevated [[triglyceride]]s, higher doses (2 to 4 g per d) may be used for risk reduction. ''(Level of Evidence: B)''}}
'''1.''' Encouraging consumption of [[omega-3 fatty acids]] in the form of fish or in capsule form (1 g per d) for risk reduction may be reasonable. For treatment of elevated [[triglyceride]]s, higher doses (2 to 4 g per d) may be used for risk reduction. ''(Level of Evidence: B)''}}

Revision as of 18:31, 1 October 2012

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Non-ST Elevation Myocardial Infarction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

ACC / AHA Guidelines - Lipid Management(DO NOT EDIT) [1][2]

“

Class I

1. The following lipid recommendations are beneficial:

a. Lipid management should include assessment of a fasting lipid profile for all patients, within 24 h of hospitalization. (Level of Evidence: C)
b. Hydroxymethyl glutaryl-coenzyme A reductase inhibitors (statins), in the absence of contraindications, regardless of baseline LDL-C and diet modification, should be given to post-UA / NSTEMI patients, including post revascularization patients. (Level of Evidence: A)
c. For hospitalized patients, lipid-lowering medications should be initiated before discharge. (Level of Evidence: A)
d. For UA / NSTEMI patients with elevated LDL-C (≥100 mg/dL), cholesterol lowering therapy should be initiated or intensified to achieve an LDL-C of <100 mg/dL. (Level of Evidence: A) Further titration to <70 mg/dL is reasonable (Level of Evidence: A)
e. Therapeutic options to reduce non HDL-C are recommended, including more intense LDL-C lowering therapy. (Level of Evidence: B)
f. Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), cholesterol (to <200 mg/d), and trans fat (to <1% of energy). (Level of Evidence: B)
g. Promoting daily physical activity and weight management are recommended. (Level of Evidence: B)

2. Treatment of triglycerides and non-HDL-C is useful, including the following:

a. If triglycerides are 200-499 mg/dL, non HDL-C should be <130 mg/dL. (Level of Evidence: B)
b. If triglycerides are ≥500 mg/dL, therapeutic options to prevent pancreatitis are fibrate or niacin before LDL-lowering therapy is recommended. It is also recommended that LDL-C be treated to goal after triglyceride lowering therapy. Achievement of a non HDL-C <130 mg/dL (i.e., 30 mg/dL greater than LDL-C target) if possible is recommended. (Level of Evidence: C)

Class IIa

1. The following lipid management strategies can be beneficial:

a. Further reduction of LDL-C to <70 mg/dL is reasonable. (Level of Evidence: A)
b. If baseline LDL cholesterol is 70-100 mg/dL, it is reasonable to treat LDL-C to less than 70 mg/dL. (Level of Evidence: B)
c. Further reduction of non HDL-C to <100 mg/dL is reasonable; if triglycerides are 200 to 499 mg/dL, non HDL-C target is <130 mg/dL. (Level of Evidence: B)
d. Therapeutic options to reduce non-HDL-C (after LDL-C lowering) include niacin or fibrate therapy.
e. Nicotinic acid (niacin) and fibric acid derivatives (fenofibrate, gemfibrozil) can be useful as therapeutic options (after LDL-C– lowering therapy) for HDL-C <40 mg/dL. (Level of Evidence: B)
f. Nicotinic acid (niacin) and fibric acid derivatives (fenofibrate, gemfibrozil) can be useful as therapeutic options (after LDL-C lowering therapy) for triglycerides >200 mg/dL. (Level of Evidence: B)
g. The addition of plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) is reasonable to further lower LDL-C. (Level of Evidence: A)

Class IIb

1. Encouraging consumption of omega-3 fatty acids in the form of fish or in capsule form (1 g per d) for risk reduction may be reasonable. For treatment of elevated triglycerides, higher doses (2 to 4 g per d) may be used for risk reduction. (Level of Evidence: B)

”

See Also

Sources

References

  1. ↑ Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS (2011). "2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". Journal of the American College of Cardiology. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Retrieved 2011-04-11. Unknown parameter |month= ignored (help)
  3. ↑ Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP (2011). "2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31820f2f3e. PMID 21444889. Retrieved 2011-03-31. Unknown parameter |month= ignored (help)

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