Coronary heart disease secondary prevention lipid management: Difference between revisions
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== Overview == | == Overview == | ||
== Lipid Management == | == 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) <ref name="pmid22052934">{{cite journal| author=Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA et al.| title=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. | journal=Circulation | year= 2011 | volume= 124 | issue= 22 | pages= 2458-73 | pmid=22052934 | doi=10.1161/CIR.0b013e318235eb4d | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22052934 }} </ref>=== | |||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Lifestyle modifications including daily physical activity and weight management are strongly recommended for all patients. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>''' | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''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). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>''' | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' In addition to therapeutic lifestyle changes, [[statin]] therapy should be prescribed in the absence of [[contraindication]]s or documented adverse effects. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])<nowiki>"</nowiki> | ||
| | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | |||
|- | |- | ||
| | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Patients who have triglycerides ≥200 mg/dL should be treated with statins to lower non–[[HDL-C] to <130 mg/dL. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor=" | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' Patients who have triglycerides >500 mg/dL should be started on [[fibrate]] therapy in addition to [[statin]] therapy to prevent [[acute pancreatitis]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | ||
|} | |} | ||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background: | | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
| bgcolor=" | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' If treatment with a [[statin]] (including trials of higher-dose [[statin]]s and higher-potency [[statin]]s) 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. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients who do not tolerate [[statin]]s, LDL-C–lowering therapy with [[bile acid sequestrant]]s and/or [[niacin]] is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to treat very high-risk patients with [[statin]] therapy to lower LDL-C to <70 mg/dL. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor=" | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In patients who are at very high risk and who have [[triglyceride]]s ≥200 mg/dL, a non–HDL-C goal of <100 mg/dL is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | ||
|} | |} | ||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>''' | |bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''1.''' The use of [[ezetimibe]] may be considered for patients who do not tolerate or achieve target LDL-C with [[statin]]s, [[bile acid sequestrant]]s, and/or [[niacin]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]]) <nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>''' | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients who continue to have an elevated non–HDL-C while on adequate [[statin]] therapy, [[niacin]] or [[fibrate]] therapy ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]]) or fish oil ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]]) may be reasonable. <nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>''' | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]]) <nowiki>"</nowiki> | ||
|} | |} | ||
Revision as of 17:35, 11 October 2012
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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.