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Ministry of Health Family Practice Residency Training Program MANAGMENMT OF HYPERLIPIDEMIA Adopted from The Third Report of the National Cholesterol Education Program (NCEP) Prepared by: Dr. Ashwak Sabt Dr. Amal Bu-Asali Dr. M. Aljalahma Revised By: Dr. Mariam AL-Jalahma Dr. Dalal Al-Hashmi Final Review: Dr. N. Das FPRP……………………………………………….……………………………..2005 New Recommendation for Screening/Detection Complete lipoprotein profile preferred Fasting total cholesterol, LDL, HDL, triglycerides after 12-14 h fasting 2 • Adults: > 20 years of age · Every 5 years with no CAD risk · Every 2 years if family history of premature CAD • Elderly patients > 75 years of age · Evaluate only if multiple risk factors for CAD • Children > 2 years and adolescents <16 years with family history of premature CAD or dyslipidemia, have hypertension, or obesity, or DM or smoker. · Once • For adolescents >16 years · Once ALGORITHM FOR Treatment decision based on LDL cholesterol Assess total Fasting lipid profile LDL > 2.6mmol/L Rule out sec. causes*** Normal Profile LDL <2.6mmol (100mg/dl) Screen every 5 years Patient with CHD Or equivalent risk ** LDL Goal <2.6 mmol(100mg) Assess risk factors* Patient with multiple risk factors +2 LDL goal < 3.36 mmol (130mg) A Patient with 0 -1 risk factors LDL goals < 4.1mmol(160mg) B C *Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals • Cigarette smoking • Hypertension (BP 140/90 mmHg or on antihypertensive medication) • Low HDL cholesterol (<40 mg/dL or 1.03 mmol /L) • Family history of premature CHD • – CHD in male first degree relative <55 years – CHD in female first degree relative <65 years Age (men 45 years; women 55 years) HDL cholesterol 60 mg/dL(1.554 mmol /L) counts as a “negative” risk factor; its presence removes one risk factor from the total count. Equivalent risk** • DM- Atherosclerosis Ds.- Multiple risk factors that confer a 10 year risk for CHD > 20% 3 •If Triglycerides are higher than 5.6mmol(500mg/dl) first reduce triglycerides, when triglycerides <5.6mmol, then treat LDL A Patient with CHD Or equivalent risk (DM) LDL Goal <2.6 mmol(100mg) LDL< 2.6(100mg) TLC & follow up 6 months Response LDL 2.6-3.3 mmol (100-129mg) LDL >3.36 mmol (130mg) TLC & follow up 3 months TLC & Drug Therapy No Response B Patient with multiple risk factors +2 LDL goal < 3.36 mmol (130mg) Assess 10 year risk for CHD < 10% 10 year risk LDL 3.36-4.1mmo 130-160mgl TLC & follow up 6 months >20% 10 year risk Manage as CHD equivalent risk LDL >4.1mmol >160mg Response 4 TLC & follow up 3 months 10-20% 10 year risk LDL >3.36mmol >130mg No Response TLC & follow up 3 months Response LDL <3.36mmol <130mg TLC & follow up 6 months Drug Therapy Follow up with LDL TLC: Therapeutic life style changes C Patient with 0 -1 risk factors LDL goal < 4.1mmol(160mg) LDL<4.1mmol <160mg LDL4.1-4.9mmol 160-189mg LDL>4.9mmol 190mg !!!Factors favoring use of drugs**** TLC & follow up 6 months Response TLC & follow up 3 months No Response **** Factors favoring use of drugs Drug Therapy In case of LDL4.1-4.9 mmol (160-189mg) the choice to start drug therapy after TLC is favored according to the following: • A severe single risk factor (heavy cigarette smoking, poorly controlled hypertension, strong family history of premature CHD, or very low HDL cholesterol}; • Multiple life-habit risk factors and emerging risk factors (if measured) • 10-year risk approaching 10% ***Ruling out Secondary Causes 5 TLC: Therapeutic life style changes Management of Specific Dyslipidemia Elevated Triglycerides 150-199mg/dL 1.64-2.26mmol primary target LDL goal •Weight reduction •Increase physical activity > 500 mg/dL >5.64mmol 200-499mg/dL 2.26-5.63mmol Monitor non -HDL cholesterol* Primary target is Triglycerides lowering •Weight reduction •Increase physical activity • Drug therapy In high risk patients ( Triglycerides lowering drugs, or Intensify LDL lowering drugs •Very low fat diet •Weight reduction •Increase physical activity •Triglycerides Lowering drugs The ATPIII encourages a more aggressive approach to hypertriglyceridemia. The major lipid component of VLDL is the triglycerides. The NCEP mentions VLDL level as part of a secondary treatment goal in patients with hypertriglyceridemia Termed as the non-HDL cholesterol ( total cholesterol minus HDL) see table 2 Table1 ATP III classification of triglycerides *Table 2 non-HDL cholesterol Normal triglycerides <1.69 mmol <150mg/dl Border line-high TG 1.69-2.26 mmol 150-199mg/dl < 2.6 < 3.36 2.26- 5.63 mmol 200- 499mg/dl < 3.36 < 4.1 > 5.64mmol >500 mg/dl < 4.1 < 4.9 High TG Very high TG Low HDL Cholesterol •No specific goal for raising HDL, no specific drug therapy, •Target should be to lower LDL cholesterol, weight reduction and increased physical activity. •Drug therapy is mostly reserved for patients with CHD & CHD risk equivalent. •In patients with low HDL & high triglycerides ( 2.26-5.63 mmol), monitor non-HDL cholesterol. Management of Very high LDL cholesterol p-190 mg/dL). Persons with very high LDL cholesterol usually have genetic forms of hypercholesterolemia: monogenic familial hypercholesterolemia, familial defective apolipoprotein B, and polygenic hypercholesterolemia. Early detection of these disorders through cholesterol testing in young adults is needed to prevent premature CHD. Family investigation is important to identify similar affected relatives. 6 Metabolic Syndrome The diagnosis of metabolic syndrome is made when three or more of the following risk determinants are present: (1.7 mmol) (1.05 mmol) (1.3 mmol) ( treatment of hypertension, use of Aspirin, treatment of elevated Triglycerides and low HDL cholesterol) 7 TLC: Therapeutic life style changes • Reduced intakes of saturated fats «7% of total calories) and cholesterol «200 mg per day) (see Table 6 for overall composition of the TLC Diet) • Therapeutic options for enhancing LDL lowering such as plant stanols/sterols (2 g/day) and increased viscous (soluble) fiber (10-25 g/day) • Weight reduction • Increased physical activity Nutrient composition of TLC diet 8 9 * Lovastatin (20-80 mg), pravastatin (20-40 mg), simvastatin (20-80 mg), fIuvastatin (20-80 mg), atorvastatin (10-80 mg), cerivastatin (0.4-0.8 mg). t Cyclosporine, macrolide antibiotics, various antifungal agents and cytochrome P-450 inhibitors (fibrates and niacin should be used with appropriate caution). + Cholestyramine (4-16 g), colestipol (5-20 g), colesevelam (2.6-3.8 g). ¥ Immediate release (crystalline) nicotinic add (1.5-3 g). extended release nicotinic acid (Niaspan @) (1-2 g). sustained release nicotinic add (1-2 g). Drug Therapy follow up steps Lipid lowering agents available in the local health centers Drugs Class Statins Fluvastatin (Lescol) Dose & Administrati on Contraindic ation Initially 2040mg HS up to 40mg BD. Liver diseases Pregnancy and lactation Pravastatin Sodium (Lipostat) Usual range 10-40 mg HS Simvstatin (Zocor)* Usual range 10-80 mg HS. Atoravastatin (Lipitor)* Fibrate Bezafibrate (bezallip retard) 10 Usual range 10-40 mg OD up to max. 80mg at any time of the day with or without food 400mg od in the morning or evening with or after meal Renal impairment Liver diseases Pregnancy and lactation Caution • Liver function test should be carried out before and within 1-3 months of starting treatment then at 6 month interval thereafter 1 year. Discontinue. If serum transaminases raises to 3 times the upper limit. Myositis:Reversiblemyositis is a rare but significant side effect.i t may be increased in those with renal impairment ,hypothyrodism, concomitant use of cyclosporine. concomitant treatment with fibrate and statins ass. With increased risk of myositis. Advise patient to report promptly unexplained muscle pain,tend,erness,weakness.Check CPK if markedly elevated (>10 times upper limit of normal)discontinue treatment. Baseline serum creatinine or creatinine clearance. If Serum creatinine>1.5 mg/dl or135mmol/l bezalip retard must not be used .Instead Bezalip tab 200mg can be used Baseline LFT (same as above) * These drugs available for referred patients only Special Considerations for different population groups Middle aged men (35 – 65 years): with relatively high risk for CHD need intensive LDL – Lowering therapy. Women ages (45 – 75 years) with multiple risk factors & metabolic syndrome cholesterol lowering drugs are preferable to hormone replacement therapy for CHD risk reduction. Older adults (men ≥ 65 & women ≥ 75 years). For primary prevention TLC is first line of therapy. LDL lowering drugs are considered for older persons with multiple risk factors or advanced sub clinical atherosclerosis. Younger adults (men 20 –35 years, women 20 – 45 years). CHD is rare except in those with severe risk factors (familial hypercholesterolemia, heavy smoking, DM). The following table show management of LDL cholesterol in young adults. LDL ≥ 130 mg TLC Drug + < < 3.36 mmol 160 – 189mg + ± + + 4.1- 4.9 mmol 190 mg 4.9 mmol 11 12 13 14