Lipid Control Today: Management within the Context of other Cardiovascular Risk Factors
Among modifiable CV risk factors, lipid abnormalities have been the focus of tireless efforts to expand public awareness and to develop improved pharmacologic interventions. Major trials over decades constitute a robust evidence base for excess CV risk associated with elevated total and low-density lipoprotein cholesterol (LDL-C); trials also show the clinical benefit of reduction in cholesterol via statin treatment. The 2013 ACC (American College of Cardiology)/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults have refined the recommendations for statin use, identifying groups that will be helped most by moderate or high-intensity statin therapy: patients with cardiovascular disease; those with LDL-C ≥190 mg/dL; those with type 2 diabetes between 40 and 75 years of age and an LDL-C of 70 mg/dL to 189 mg/dL; and those with an estimated 10-year risk of cardiovascular disease of 7.5% or higher between 40 and 75 years of age and an LDL-C of 70 mg/dL to 189 mg/dL.
An interesting and important aspect of these recent guidelines is that some of the statin recommendations occur in the context of additional cardiovascular risk factors: type 2 diabetes, age, and overall 10-year risk, which includes risk factors like hypertension and smoking. This approach reflects a growing opinion—first reflected a decade ago in the National Heart, Lung, and Blood Institute’s ATP III education program (NHLBI ATP III) and in the delineation of metabolic syndrome: Cardiovascular risk is determined by a nexus of risk factors that work together.
Two key questions emerge for today’s clinicians which is the proper philosophy of management: First, should the goal be maximal, independent control of lipid abnormalities or a more holistic approach that manages the patient’s overall CVD risk profile? Second, how will the PCSK9 inhibitors fit in to the overall management of CVD risk? Answering these questions constitute important, unmet educational needs.
After completing this activity, the participant should be better able to:
- Describe the recent evidence-based recommendations from AHA on cholesterol management
- Interpret the control of hyperlipidemia in the context of other modifiable and non-modifiable cardiovascular risk factors, including hypertension, diabetes, and age
- Examine the introduction of PCSK9 inhibitors, through an understanding of expert opinion on how these agents will fit into current algorithms
This activity has expired and is no longer available for CME; however, we hope you still enjoy the education.
Published August, 2015
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