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
Goal: Treatment with statin therapy; use statin therapy to achieve an LDL-C of <100 mg/dL; for very high risk* patients an LDL-C <70 mg/dL is reasonable; if triglycerides are ≥200 mg/dL, non–HDL-C† should be <130 mg/dL, whereas non–HDL-C <100 mg/dL for very high risk patients is reasonable.
AHA/ACC 2011 Guidelines - Coronary Heart Disease - Secondary Prevention with Lipid Management (DO NOT EDIT) [1]
| Class I |
| "1. A lipid profile in all patients should be established, and for hospitalized patients, lipid-lowering therapy as recommended below should be initiated before discharge. (Level of Evidence: B)" |
| "2. Lifestyle modifications including daily physical activity and weight management are strongly recommended for all patients. (Level of Evidence: B)" |
| "3. Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), transfatty acids (to <1% of total calories), and cholesterol (to <200 mg/d). (Level of Evidence: B)" |
| "4. In addition to therapeutic lifestyle changes, statin therapy should be prescribed in the absence of contraindications or documented adverse effects. (Level of Evidence: A)" |
| "5. An adequate dose of statin should be used that reduces [[LDL-C] to <100 mg/dL AND achieves at least a 30% lowering of LDL-C. (Level of Evidence: C)" |
| "6. Patients who have triglycerides ≥200 mg/dL should be treated with statins to lower non–[[HDL-C] to <130 mg/dL. (Level of Evidence: B)" |
| "7. Patients who have triglycerides >500 mg/dL should be started on fibrate therapy in addition to statin therapy to prevent acute pancreatitis. (Level of Evidence: C)" |
| Class IIa |
| "1. If treatment with a statin (including trials of higher-dose statins and higher-potency statins) does not achieve the goal selected for a patient, intensification of LDL-C-lowering drug therapy with a bile acid sequestrant or niacin is reasonable. (Level of Evidence: B)" |
| "2. For patients who do not tolerate statins, LDL-C–lowering therapy with bile acid sequestrants and/or niacin is reasonable. (Level of Evidence: B)" |
| "3. It is reasonable to treat very high-risk patients with statin therapy to lower LDL-C to <70 mg/dL. (Level of Evidence: C)" |
| "4. In patients who are at very high risk and who have triglycerides ≥200 mg/dL, a non–HDL-C goal of <100 mg/dL is reasonable. (Level of Evidence: B)" |
| Class IIb |
| "1. The use of ezetimibe may be considered for patients who do not tolerate or achieve target LDL-C with statins, bile acid sequestrants, and/or niacin. (Level of Evidence:C) " |
| "2. For patients who continue to have an elevated non–HDL-C while on adequate statin therapy, niacin or fibrate therapy (Level of Evidence:B) or fish oil (Level of Evidence:C) may be reasonable. " |
| "3. For all patients, it may be reasonable to recommend omega-3 fatty acids from fish or fish oil capsules (1 g/d) for cardiovascular disease risk reduction. (Level of Evidence:B) " |
References
- ↑ Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation". Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.