Coronary heart disease secondary prevention lipid management
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Lipid Management
AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update (DO NOT EDIT)
Goal: LDL-C <100 mg/dL; If triglycerides are ≥200 mg/dL, non-HDL-C should be <130 mg/dL.
For all patients:
| Class I |
| "1. Start dietary therapy. Reduce intake of saturated fats (to <7% of total calories), trans-fatty acids, and cholesterol (to <200 mg/d). (Level of Evidence: B)" |
| "2. Adding plant stanol/sterols (2 g/d) and viscous fiber (>10 g/d) will further lower LDL-C." |
| "3. Promote daily physical activity and weight management. (Level of Evidence: B)" |
| Class II |
| "1. Encourage increased consumption of omega-3 fatty acids in the form of fish or in capsule form (1 g/d) for risk reduction. For treatment of elevated triglycerides, higher doses are usually necessary for risk reduction. (Level of Evidence: B)" |
For lipid management:Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiate lipid-lowering medication as recommended below before discharge according to the following schedule:
| Class I |
| "a. LDL-C should be <100 mg/dL. (Level of Evidence: A)" |
| "b. If baseline LDL-C is ≥100 mg/dL, initiate LDL-lowering drug therapy. (Level of Evidence: A) " |
| "c. If on-treatment LDL-C is ≥100 mg/dL, intensify LDL-lowering drug therapy (may require LDL-lowering drug combination). (Level of Evidence: A) " |
| "d. If triglycerides are 200 to 499 mg/dL, non-HDL-C should be <130 mg/dL. (Level of Evidence:B) " |
| "e. Therapeutic options to reduce non HDL - C are more intense LDL - C lowering therapy. (Level of Evidence:B) " |
| "f. If triglycerides are ≥500 mg/dL, therapeutic options to prevent pancreatitis are fibrate or niacin before LDL-lowering therapy; and treat LDL-C to goal after triglyceride-lowering therapy. Achieve non-HDL-C <130 mg/dL if possible. (Level of Evidence:C) " |
| Class IIa |
| "a. Reduction of LDL-C to <70 mg/dL is reasonable. (Level of Evidence:A) " |
| "b. If baseline LDL-C is 70 to 100 mg/dL, it is reasonable to treat to LDL-C <70 mg/dL. (Level of Evidence:B) " |
| "c. If triglycerides are 200 to 499 mg/dL, reduction of non-HDL-C to <100 mg/dL is reasonable. (Level of Evidence:B) " |
| "d. Therapeutic options to reduce non HDL - C are Niacin (after LDL-C loweing therapy). (Level of Evidence:B) " |
| "e. Therapeutic options to reduce non HDL - C are Fibrate therapy (after LDL-C loweing therapy). (Level of Evidence:B) " |