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lipid disorder (dyslipidemia)

see hyperlipidemia or more specific type Pathology: - adverse consequences of dyslipidemia begin early in life [8] Laboratory: - screening with lipid panel - adults 40-75 years of age (USPSTF) - annually for high-risk patients - every 4 years for patients with borderline LDL cholesterol [17] - every 5 years for patients at low risk with normal lipid profiles [18] - longer intervals may be considered for consistently normal results [7] - no specific LDL cholesterol or non-HDL cholesterol targets recommended [12] - nonfasting lipid panel no more than every 10 years [[16] - additional testing to refine risk prediction is not recommended [12], - serum CRP marginally improves risk predictive, thus not recommended [12] - fasting lipid measurement is not required - nonfasting total cholesterol & HDL cholesterol levels differ little from fasting measurements [12] - fasting LDL cholesterol levels might be 10% lower than a - fasting serum triglyceride levels might be 20% lower than a fasting level [12] - baseline testing should be obtained before initiating statin therapy [12] - serum creatine kinase levels - not indicated in the absence of myalgias [7] - liver function tests - routine monitoring of serum lipids, serum creatine kinase, or liver function tests during follow-up is not recommended [12] Radiology: - coronary artery calcium - may improve risk prediction, but effect is considered small - no evidence that testing improves outcomes, thus not recommended [12,16] Management: - dietary intervention is always indicated [7] a) limit total fat to 25-35% of calories b) limit saturated fat to < 7% of calories - Mediterranean diet recommended for primarg & secondary prevention [16] - aerobic exercise of any intensity & duration is recommended [16] - statins - no benefit of statin if 10 year cardiovascular (CV) risk is < 6% - limited evidence of benefit (~8% CV risk reduction) when 10 year CV risk reduction is 6-12% - net benefit of statins in this group is uncertain - decision to initiate therapy should be shared with the patient [12] - with 10 year CV risk is >12%, statins lower CV risk by 20-30% [12] - treat to target statin dose not to LDL cholesterol [16] - moderate-dose statin therapy for secondary prevention - additive benefit of high-dose statin therapy is relatively small - ~ 6 fewer adverse CV events per 1000 patients treated with high-dose vs moderate-dose statin for 5 years [12] - AHA/ACC recommendations for statin therapy - LDL cholesterol > 190 mg/dL - LDL-cholesterol > 70 mg/dL AND - diabetes mellitus OR - 10 year cardiovascular risk >= 7.5% [13] - PCSK9 inhibitors - not recommended for primary prevention [16] - recommended if risk factors, on maximum statin & ezetimibe therapy & LDL-cholesterol > 130 mg/dL [7] - no benefit in lowering LDL cholesterol below 70 mg/dL [7]

Related

lipid panel (fasting lipid panel, FLP)

Specific

hyperlipidemia hyperlipoproteinemia (HLP) hypolipoproteinemia lipid metabolism, inborn error; lipid storage disease; lipidosis lipodystrophy; lipoatrophy lipomatosis steatosis; fatty liver; nonalcoholic fatty liver disease (NAFLD); metabolic dysfunction-associated steatotic liver disease (MASLD)

General

metabolic disease syndrome

Figures/Diagrams

Dyslipoproteinemias

References

  1. Fletcher B, Berra K, Ades P, Braun LT, Burke LE, Durstine JL, Fair JM, Fletcher GF, Goff D, Hayman LL, Hiatt WR, Miller NH, Krauss R, Kris-Etherton P, Stone N, Wilterdink J, Winston M; Council on Cardiovascular Nursing; Council on Arteriosclerosis, Thrombosis, and Vascular Biology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Nutrition, Physical Activity, and Metabolism; Council on Stroke; Preventive Cardiovascular Nurses Association. Managing abnormal blood lipids: a collaborative approach. Circulation. 2005 Nov 15;112(20):3184-209. PMID: 16286609 http://circ.ahajournals.org/cgi/content/full/112/20/3184
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  3. Prescriber's Letter 15(8): 2008 COMMENTARY: Treatment of Hyperlipidemia in Children and Adolescents GUIDELINES: Lipid Screening and Cardiovascular Health in Childhood GUIDELINES: Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents GUIDELINES: Management of Dyslipidemia in Children and Adolescents with Diabetes Detail-Document#: 240803 (subscription needed) http://www.prescribersletter.com
  4. Updated VA/DoD guideline on the management of dyslipidemia http://www.oqp.med.va.gov/cpg/DL/DL_base.htm (updated NGC May 18, 2015)
  5. Screening for lipid disorders in adults deprecated reference - National Guideline Clearinghouse United States Preventive Services Task Force (USPSTF) Department of Veterans Affairs, Department of Defense (VA/DoD). (correpsonding NGC guideline withdrawn Jan 2014)
  6. Prescriber's Letter 17(1): 2010 Second-Line Therapy of Dyslipidemia RESOURCE: Niacin Titration Schedule PATIENT HANDOUT: What You Should Know About Niacin COMMENTARY: Ezetimibe vs. Niacin for Atherosclerosis: The ARBITER 6-HALTS Study CHART: Non-Statin Lipid-Lowering Agents Detail-Document#: 260101 (subscription needed) http://www.prescribersletter.com
  7. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2021 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  8. Pletcher MJ et al. Nonoptimal lipids commonly present in young adults and coronary calcium later in life: The CARDIA (Coronary Artery Risk Development in Young Adults) study. Ann Intern Med 2010 Aug 3; 153:137. PMID: 20679558
  9. Prescriber's Letter 19(1): 2012 Treatment of Hyperlipidemia in Children and Adolescents Detail-Document#: 280106 (subscription needed) http://www.prescribersletter.com - Daniels SR et al Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report (2011) http://www.nhlbi.nih.gov/guidelines/cvd_ped/peds_guidelines_sum.pdf
  10. Alwaili K, Alrasadi K, Awan Z, Genest J. Approach to the diagnosis and management of lipoprotein disorders. Curr Opin Endocrinol Diabetes Obes. 2009 Apr;16(2):132-40. PMID: 19306526
  11. Prescriber's Letter 20(4): 2013 Evidence-Based Strategies for Managing Hypertension and Dyslipidemia. Detail-Document#: 290421 (subscription needed) http://www.prescribersletter.com
  12. Downs JR and O'Malley PG. Management of dyslipidemia for cardiovascular disease risk reduction: Synopsis of the 2014 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Ann Intern Med 2015 Jun 23
  13. Stone NJ et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Am Coll Cardiol 2013 Nov 12 PMID: 24222016 http://content.onlinejacc.org/article.aspx?articleid=1770217
  14. Lozano P, Henrikson NB, Morrison CC, Dunn J et al Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016 Aug 9;316(6):634-644. PMID: 27532918
  15. White J, Swerdlow DI, Preiss D et al. Association of lipid fractions with risks for coronary artery disease and diabetes. JAMA Cardiol 2016 Aug 3 PMID: 27487401
  16. O'Malley PG et al Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. Sept 22, 2020 PMID: 32956597 https://www.acpjournals.org/doi/10.7326/M20-4648 - Reston JT et al Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease. A Systematic Review for the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Dyslipidemia. Ann Intern Med. Sept 22, 2020 PMID: 32956601 https://www.acpjournals.org/doi/10.7326/M20-4680 - Bailey AL, Campbell CL. The U.S. Department of Veterans Affairs and U.S. Department of Defense Guideline for the Management of Dyslipidemia: Is Moderate Risk Reduction Enough? Ann Intern Med. Sept 22, 2020 PMID: 32956605 https://www.acpjournals.org/doi/10.7326/M20-6125 - VA/DoD Clinical Practice Guidelines The Management of Dyslipidemia for Cardiovascular Risk Reduction (Lipids) (2020) https://www.healthquality.va.gov/guidelines/CD/lipids/
  17. Stone NJ et al 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk on Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. Nov 12, 2013 PMID: 24222016 http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a
  18. Di Angelantonio E et al. for the Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009 Nov 11; 302:1993. PMID: 19903920
  19. Wilkinson MJ Defining and Treating Dyslipidemia. VuMedi. March 6, 2024 555 12th Street, Suite 1775 | Oakland | CA | 94607 https://www.vumedi.com/video/defining-and-treating-dyslipidemia/