Management of dyslipidemia | AHA guidelines | Statins

Summary

In this educational video for healthcare professionals, the focus is on managing dyslipidemia, specifically when to start statin therapy based on LDL cholesterol levels. The discussion covers primary and secondary prevention, emphasizing lifestyle modifications and medication guidelines, including high, moderate, and low-intensity statins. The video also addresses managing triglycerides and low HDL cholesterol, noting the importance of continuous treatment and patient-specific considerations. Viewers are encouraged to share their experiences and questions in the comments for further discussion.

Takeaways

• 📚 This video is intended for educational purposes for healthcare professionals and not for prescription or endorsement of any brand.
• 🧬 Dyslipidemia management includes starting statins based on LDL cholesterol levels, with high-intensity statins recommended for levels ≥190 mg/dL.
• 👩‍⚕️ Primary prevention involves preventing the development of risk factors into disease, targeting LDL levels through lifestyle changes and statins.
• 💊 High-intensity statins reduce LDL cholesterol by more than 50%, moderate intensity by 30-49%, and low intensity by less than 30%.
• 🔍 In India, LDL levels are usually rechecked after 12 weeks of starting statins to assess effectiveness.
• 🔬 Secondary prevention aims to prevent recurrence of diseases like myocardial infarction or stroke by maintaining LDL levels below 70 mg/dL.
• 🏋️‍♀️ Lifestyle modification is crucial for managing high triglyceride levels, with emphasis on reducing alcohol intake and avoiding saturated fats.
• 🧒 For children with familial hypercholesterolemia, lifestyle changes are prioritized, but statins may be considered depending on risk factors.
• 🌡️ Diabetic patients are managed with statins based on their age, duration of diabetes, and presence of complications like retinopathy or neuropathy.
• 💰 Cost considerations are important when adding medications like PCSK9 inhibitors, which are expensive but effective in reducing LDL levels.

Q & A

What is the primary purpose of the video?

The video is meant to educate healthcare professionals on how to manage dyslipidemia. It is not a prescription or an endorsement of any brand or company.

What is the significance of LDL cholesterol levels in dyslipidemia management?

Lowering LDL cholesterol levels can reduce the risk of atherosclerosis. For primary prevention, if LDL levels are equal to or more than 190 mg/dL, high-intensity statins should be started.

What is primary prevention in the context of dyslipidemia?

Primary prevention refers to preventing the development of risk factors into a disease. It involves starting treatment before any clinical evidence of myocardial infarction, angina, or stroke is present.

When should high-intensity statins be started?

High-intensity statins should be started if LDL cholesterol levels are equal to or more than 190 mg/dL, irrespective of whether the patient has diabetes or other risk factors.

How often should LDL levels be checked after starting high-intensity statins?

LDL levels should be checked again after 4 to 12 weeks. In India, it is usually done after 12 weeks.

Can statins be stopped if cholesterol levels are controlled?

According to guidelines, statins should not be stopped even if cholesterol levels are controlled. Statins are considered lifelong treatment.

What should be done if LDL levels remain above 100 mg/dL despite statin therapy?

If LDL levels remain above 100 mg/dL, a non-statin drug that inhibits cholesterol absorption from the intestine, like ezetimibe, may be added. If needed, PCSK9 inhibitors can also be considered.

What are the criteria for using PCSK9 inhibitors?

PCSK9 inhibitors are considered if LDL levels remain above 100 mg/dL after statin and non-statin therapy, and there are risk factors for atherosclerotic cardiovascular disease. These medications are costly and should be used with cost considerations in mind.

What lifestyle modifications are recommended for managing dyslipidemia in younger patients?

Lifestyle modifications include encouraging physical activity, avoiding junk food, and reducing saturated fats in the diet. These are especially recommended for patients under 19 years of age.

How should dyslipidemia be managed in patients over 75 years of age?

In patients over 75 years, the decision to start or continue statin therapy should be individualized. The potential side effects of statins versus the benefits should be discussed with the patient.