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Last Updated: 11/15/2013  

Lipid Disorders (Dyslipidemia)

Screening
  • Screen high-risk adults and all men aged 35 or older and women aged 45 or older for lipid disorders by checking either a fasting lipid profile or a total cholesterol and HDL. Screen low-risk adults every 5 years.

Diagnosis
  • Use history to identify LDL cholesterol treatment thresholds and goals for therapy, classifying patients as:

    • CHD or CHD risk equivalent (goal LDL <100 mg/dl)

    • Moderate risk (goal LDL <130 mg/dL)

    • Low risk (goal LDL <160 mg/dL)

  • Check a fasting lipid profile to diagnose lipid disorders.

  • Consider additional laboratory and other studies in select patients with either abnormal lipid profiles or unclear need for drug therapy including:

    • Direct LDL in patients with elevated triglycerides

    • Coronary artery calcium or CRP ONLY in patients at intermediate risk in hwom the result would determine the need for drug therapy

  • Rule out secondary causes of lipid disorders.

Therapy
  • Initiate dietary therapy with a Mediterranean or low-fat diet in patients with hyperlipidemia and recommend exercise for all patients.

  • Begin statin therapy based on patients' cardiovascular risk.

    • In patients with known cardiovascular disease, provide a high-intensity statin unless contraindicated or not tolerated.

    • In patients with LDL ≥190 mg/dL, provide a high-intensity statin unless contraindicated or not tolerated.

    • In patients with diabetes but no known cardiovascular disease, provide moderate-intensity or high-intensity statin therapy.

    • Treat other patients according to the calculated risk for cardiovascular disease, providing a high-intensity statin to patients between the ages of 40 and 75 years with at least a 10% calculated 10-year risk.

  • Use medications to lower triglycerides in patients with triglycerides >1000 mg/dL.

  • Individualize therapy and consider combination drug therapy in specific patients.

DOI: 10.7326/d176
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Thomas A. Pearson, MD, PhD, FACP is a consultant for Bristol-Myers Squibb, Bayer, J and J Merck, Merck/Schering Plough, Sanofi-Adventis, Forbes/Meditech, received honorarium from Abbott, AstraZeneca, Bayer, Bristol-Myers/Squibb, KOS, Pfizer, Merck/Schering Plough, Merck & Co., received grants from KOS, Merck & Co., Pfizer, Sanofi/Adventis. Laurie A. Kopin, Ed.D, MS, RN, ANP, FPCNA has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Daniel Soffer, MD received a one-time consulting fee from Aegerion, grant funding from Sanofi/Regeneron, and an educational grant from Roche Genentch.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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