Chronic stable angina treatment lipid management
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Chronic stable angina Microchapters | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Alternative Therapies for Refractory Angina | ||
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Risk calculators and risk factors for Chronic stable angina treatment lipid management | ||
Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD
Lipid Management
- Recommended lipid management includes assessment of a fasting lipid profile.
- Primary goal of lipid management is to achieve a LDL-C level of less than 100 mg/dL.
- If baseline LDL-C is greater than or equal to 100 mg per dL, LDL lowering drug therapy should be initiated in addition to therapeutic lifestyle changes.
- When LDL-lowering medications are used in high-risk or moderately high-risk persons, it is recommended that intensity of therapy be sufficient to achieve a 30% to 40% reduction in LDL-C levels.
- If on-treatment LDL-C is greater than or equal to 100 mg per dL, LDL-lowering drug therapy should be intensified.
- If baseline LDL-C is 70 to 100 mg per dL, it is reasonable to treat LDL-C to less than 70 mg per dL.
- Secondary goal of lipid management is to achieve non–HDL-C‡ of less than 130 mg per dL if triglycerides are 200 to 499 mg per dL.
- Further reduction of non–HDL-C‡ to less than 100 mg per dL is reasonable, if triglycerides are greater than or equal to 200 to 499 mg per dL.
- Therapeutic options to reduce non–HDL-C are:
- Niacin can be useful as a therapeutic option to reduce non–HDL-C (after LDL-C–lowering therapy) or
- Fibrate therapy as a therapeutic option can be useful to reduce non–HDL-C‡ (after LDL-C–lowering therapy).
- If triglycerides are greater than or equal to 500 mg per dL, therapeutic options to lower the triglycerides to reduce the risk of pancreatitis are fibrate or niacin; these should be initiated before LDL-C lowering therapy. The goal is to achieve non–HDL-C‡ less than 130 mg per dL if possible.
- Other recommended strategies for lipid lowering and diet management are:
- Reduced intake of saturated fats (to less than 7% of total calories), trans-fatty acids, and cholesterol (to less than 200mg per day).
- Adding plant stanol/sterols (2g per day) and/or viscous fiber (greater than 10 g per day) is reasonable to further lower LDL-C.
- Encouraging consumption of omega-3 fatty acids in the form of fish or in capsule form (1g per day) for risk reduction.
- Daily physical activity and weight management are recommended for all patients.
- Moderation of alcohol consumption.
- Limited sodium intake.
ACC / AHA Guidelines for cardiovascular risk factor reduction- Lipid management (DO NOT EDIT)[1][2]
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Class I1. Low-density lipoprotein-lowering therapy in patients with documented or suspected CAD and LDL more than or equal to 130 mg/dL, with a target LDL cholesterol less than or equal to 100 mg per dl. (Level of Evidence: A) 2. If triglycerides are 200 to 499 mg per dL, non–HDL-C‡ should be less than 130 mg per dL. (Level of Evidence: B) 3. If triglycerides are greater than or equal to 500 mg per dL, therapeutic options to lower the triglycerides to reduce the risk of pancreatitis are fibrate or niacin; these should be initiated before LDL-C lowering therapy. The goal is to achieve non–HDL-C‡ less than 130 mg per dL if possible. (Level of Evidence: C) 4. Dietary therapy for all patients should include reduced intake of saturated fats (to less than 7% of total calories), trans-fatty acids, and cholesterol (to less than 200 mg per day). (Level of Evidence: B) Class IIa1. In patients with documented or suspected CAD and low-density lipoprotein (LDL) cholesterol 100 to 129 mg/dL, several therapeutic options are available: (Level of Evidence: B)
2. Therapy to lower non-HDL cholesterol in patients with documented or suspected CAD and triglyceride levels greater than 200 mg/dL, with a target non-HDL cholesterol level of less than 130 mg/dL. (Level of Evidence: B) |
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See Also
Sources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).Circulation 99 (21):2829-48. PMID: 10351980
- ↑ 2.0 2.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462