Unstable angina / non ST elevation myocardial infarction lipid managment: Difference between revisions

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#redirect:[[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention]]
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==Overview of Lipid Management in UA / NSTEMI==
 
==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>==
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===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 (Class IIa, 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 fat]]s (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 [[triglyceride]]s and [[non-HDL-C]] is useful, including the following:
 
::a. If [[triglyceride]]s are 200-499 mg/dL, [[non HDL-C]] should be <130 mg/dL. (Level of Evidence: B)
::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===
 
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 [[triglyceride]]s 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 [[triglyceride]]s >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 [[triglyceride]]s, higher doses (2 to 4 g per d) may be used for risk reduction. (Level of Evidence: B)}}
 
==Sources==
*The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>
 
==References==
{{reflist|2}}
 
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