What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Dyslipidemia, or abnormal lipid levels in the blood, increases the risk of atherosclerosis and cardiovascular disease. The document discusses the definition and causes of dyslipidemia as well as screening recommendations. It also summarizes the roles of different lipids like LDL, HDL, and triglycerides in atherosclerosis. The treatment approaches for different lipid abnormalities are outlined, including lifestyle modifications and medications like statins, fibrates, bile acid sequestrants, nicotinic acid, and ezetimibe.
This document provides guidelines for the assessment and management of dyslipidemia from several major organizations. It discusses risk assessment tools for cardiovascular disease from ATP III, ADA, ACC/AHA, and QRISK2. It also compares statin intensity categories between NICE and ACC/AHA guidelines. The document recommends lifestyle modification as first-line treatment and the use of high-intensity statins for primary and secondary prevention of CVD according to the guidelines of NICE, ADA, and ACC/AHA.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
Hypertension and Diabetic Kidney Disease Progression Hypertension and Diabe...MedicineAndHealthUSA
Hypertension and diabetic kidney disease progression are linked, and reducing proteinuria is key to slowing kidney disease. The document discusses how conditions like hypertension and diabetes that cause kidney damage have increased in the US population. Landmark trials found that lowering blood pressure and proteinuria reduced kidney disease progression and cardiovascular risks. Initial therapy for kidney or diabetes patients should be an ACE inhibitor or ARB to target blood pressure under 130/80 mmHg.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Dyslipidemia, or abnormal lipid levels in the blood, increases the risk of atherosclerosis and cardiovascular disease. The document discusses the definition and causes of dyslipidemia as well as screening recommendations. It also summarizes the roles of different lipids like LDL, HDL, and triglycerides in atherosclerosis. The treatment approaches for different lipid abnormalities are outlined, including lifestyle modifications and medications like statins, fibrates, bile acid sequestrants, nicotinic acid, and ezetimibe.
This document provides guidelines for the assessment and management of dyslipidemia from several major organizations. It discusses risk assessment tools for cardiovascular disease from ATP III, ADA, ACC/AHA, and QRISK2. It also compares statin intensity categories between NICE and ACC/AHA guidelines. The document recommends lifestyle modification as first-line treatment and the use of high-intensity statins for primary and secondary prevention of CVD according to the guidelines of NICE, ADA, and ACC/AHA.
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.
Several distinct types of DM are caused by a complex interaction of genetics and environmental factors.
Depending on the etiology of the DM, factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production.
The metabolic dysregulation associated with DM causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual with diabetes and on the health care system.
Hypertension and Diabetic Kidney Disease Progression Hypertension and Diabe...MedicineAndHealthUSA
Hypertension and diabetic kidney disease progression are linked, and reducing proteinuria is key to slowing kidney disease. The document discusses how conditions like hypertension and diabetes that cause kidney damage have increased in the US population. Landmark trials found that lowering blood pressure and proteinuria reduced kidney disease progression and cardiovascular risks. Initial therapy for kidney or diabetes patients should be an ACE inhibitor or ARB to target blood pressure under 130/80 mmHg.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
This document provides an overview of dyslipidemia including the physiology of lipid metabolism, the role of lipoproteins in atherosclerosis, screening and treatment approaches. It covers topics such as the exogenous and endogenous pathways of lipid metabolism, key enzymes involved, how lipids contribute to atherosclerosis, diagnostic evaluation, and management with an emphasis on statin therapy and other lipid-lowering drug classes and their mechanisms of action and side effects.
This document is the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. It was written by a committee of experts and provides recommendations to reduce the risk of atherosclerotic cardiovascular disease through cholesterol management. The guideline covers topics such as measurements of LDL-C and other lipids, therapeutic lifestyle changes, lipid-lowering drugs including statins, and recommendations for different patient groups including those with secondary prevention of ASCVD or severe hypercholesterolemia.
Diabetic Dyslipidemia
By Dr. Usama Ragab Youssif
ISMA CME Activity 2021
In Tolip EL Galala Hotel
-----------
Introduction
Physiology of lipid metabolism
Pathophysiology of diabetic dyslipidemia
Statin therapy (+/- ezetimibe) evidence and translation of evidence
Residual CV risk: excess TG
EPA therapy evidence and translation of evidence
Dr. Vivek Baliga discusses diabetic dyslipidemia and emerging concepts in its management. Non-HDL cholesterol is a better indicator of cardiovascular risk than LDL cholesterol. It encompasses all potentially atherogenic lipoproteins. Dual PPAR alpha/gamma agonists like saroglitazar can effectively control dyslipidemia and maintain glycemic control in patients with diabetes by reducing triglycerides and non-HDL cholesterol while improving other lipid and glucose parameters. Saroglitazar is approved in India for the treatment of diabetic dyslipidemia.
- The patient is a 50-year-old male smoker with hypertension for 6 years. His lipid profile shows a total cholesterol of 210 mg/dL, triglycerides of 180 mg/dL, LDL of 119 mg/dL, and HDL of 30 mg/dL.
- According to guidelines, he is at high cardiovascular risk due to smoking, hypertension, and lipid levels. Egypt is also considered a very high risk country.
- The appropriate measures for this high risk patient include lifestyle modifications plus high-intensity statin therapy, with an LDL cholesterol goal of less than 70 mg/dL. Monitoring is also needed.
The document provides guidelines for cholesterol management and cardiovascular disease (CVD) risk assessment. It discusses guidelines for measuring cholesterol and lipid levels, calculating LDL and VLDL values, and assessing CVD risk. It recommends starting moderate- or high-intensity statin therapy for most adults aged 40-75 years with diabetes or LDL ≥70 mg/dL. For those without diabetes but with a CVD risk of 7.5% or higher, it recommends discussing statin therapy. The guidelines also provide recommendations for managing statin side effects, evaluating risk factors, and refining risk assessment using coronary artery calcium scoring. The main messages are to emphasize lifestyle changes, use high-intensity statins for high-risk patients, and consider patient risk
This document discusses guidelines for managing dyslipidemia with statins. It identifies 4 main groups that benefit from statin treatment based on their ASCVD risk: 1) those with clinical ASCVD, 2) those with LDL-C >190 mg/dL, 3) those with diabetes aged 40-75 with LDL-C 70-189 mg/dL, and 4) those aged 40-75 without clinical ASCVD or diabetes but with LDL-C 70-189 mg/dL and 10-year ASCVD risk >7.5%. The document reviews evidence that moderate- and high-intensity statin therapy lowers ASCVD risk across all baseline LDL-C levels above 70 mg/dL. It provides guidance on
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
LDL Cholesterol Target :“ Lower the Better ”Arindam Pande
Lowering LDL cholesterol provides significant cardiovascular benefits and reduces risk, even in those with low baseline LDL levels or who achieve very low LDL levels with treatment. While residual risk remains even with intensive statin therapy to lower LDL well below current target levels, risk continues to decrease as LDL is further lowered. The lower the achieved LDL level, the lower the long-term risk of major cardiovascular events and atherosclerotic progression.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
This document summarizes guidelines for managing diabetes in cardiac patients from the American Diabetes Association in 2011. It discusses studies that show intensive glucose control reduces cardiovascular outcomes for type 2 diabetes patients. However, the ACCORD trial found intensive control increased mortality, likely due to hypoglycemia. The ADA evidence grading system and criteria for diagnosing diabetes are also presented.
This document provides guidelines and recommendations for lipid management:
1. It summarizes the 2013 ACC/AHA guidelines and 2016 ACC expert consensus, focusing on proven therapy rather than arbitrary lipid targets. Lifestyle changes like diet and exercise are encouraged for all.
2. Statins are recommended for four major groups to reduce ASCVD risk. High, moderate, and low intensity statin therapies are defined based on average LDL-C reduction.
3. For patients who are truly statin intolerant or require additional lowering, the document provides guidance on use of non-statin therapies like ezetimibe, basing selection on risk level and comorbidities.
This document discusses glucose-lowering therapies and the clinical place of SGLT2 inhibitor agents. It presents the case of a 52-year-old male patient with type 2 diabetes, hypertension, and coronary artery disease. It analyzes adding empagliflozin or sitagliptin to the patient's current metformin regimen and reviews long-term trial data showing empagliflozin's superior effects on HbA1c reduction, weight loss, and hypoglycemia risk reduction compared to glimepiride. The document also discusses empagliflozin's benefits on blood pressure and potential cardioprotective mechanisms of action beyond glycemic control such as reducing cardiac fibrosis. It emphasizes the importance of individual
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
The document provides guidelines from a committee for managing blood cholesterol to reduce atherosclerotic cardiovascular disease risk. It includes 10 key recommendations, such as emphasizing lifestyle changes for all ages, using high-intensity statin therapy for patients with clinical ASCVD, considering additional nonstatin drugs for very high risk patients, and assessing adherence to medication and lifestyle changes. The guidelines cover measuring cholesterol levels, risk assessment, and treatment approaches for different patient groups including those with diabetes or severe hypercholesterolemia.
1. The new guidelines recommend initiating moderate or high-intensity statin therapy for patients in four categories based on their cardiovascular risk, rather than targeting a specific LDL-C level.
2. The four categories are: individuals with clinical atherosclerotic cardiovascular disease, LDL-C over 190 mg/dL, diabetes between ages 40-75 with LDL-C 70-189 mg/dL, and 10-year risk over 7.5% for ages 40-75 with LDL-C 70-189 mg/dL.
3. Lipids should be measured during follow-ups to assess adherence, not to achieve a specific target level.
This document provides an overview of dyslipidemia including the physiology of lipid metabolism, the role of lipoproteins in atherosclerosis, screening and treatment approaches. It covers topics such as the exogenous and endogenous pathways of lipid metabolism, key enzymes involved, how lipids contribute to atherosclerosis, diagnostic evaluation, and management with an emphasis on statin therapy and other lipid-lowering drug classes and their mechanisms of action and side effects.
This document is the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. It was written by a committee of experts and provides recommendations to reduce the risk of atherosclerotic cardiovascular disease through cholesterol management. The guideline covers topics such as measurements of LDL-C and other lipids, therapeutic lifestyle changes, lipid-lowering drugs including statins, and recommendations for different patient groups including those with secondary prevention of ASCVD or severe hypercholesterolemia.
Diabetic Dyslipidemia
By Dr. Usama Ragab Youssif
ISMA CME Activity 2021
In Tolip EL Galala Hotel
-----------
Introduction
Physiology of lipid metabolism
Pathophysiology of diabetic dyslipidemia
Statin therapy (+/- ezetimibe) evidence and translation of evidence
Residual CV risk: excess TG
EPA therapy evidence and translation of evidence
Dr. Vivek Baliga discusses diabetic dyslipidemia and emerging concepts in its management. Non-HDL cholesterol is a better indicator of cardiovascular risk than LDL cholesterol. It encompasses all potentially atherogenic lipoproteins. Dual PPAR alpha/gamma agonists like saroglitazar can effectively control dyslipidemia and maintain glycemic control in patients with diabetes by reducing triglycerides and non-HDL cholesterol while improving other lipid and glucose parameters. Saroglitazar is approved in India for the treatment of diabetic dyslipidemia.
- The patient is a 50-year-old male smoker with hypertension for 6 years. His lipid profile shows a total cholesterol of 210 mg/dL, triglycerides of 180 mg/dL, LDL of 119 mg/dL, and HDL of 30 mg/dL.
- According to guidelines, he is at high cardiovascular risk due to smoking, hypertension, and lipid levels. Egypt is also considered a very high risk country.
- The appropriate measures for this high risk patient include lifestyle modifications plus high-intensity statin therapy, with an LDL cholesterol goal of less than 70 mg/dL. Monitoring is also needed.
The document provides guidelines for cholesterol management and cardiovascular disease (CVD) risk assessment. It discusses guidelines for measuring cholesterol and lipid levels, calculating LDL and VLDL values, and assessing CVD risk. It recommends starting moderate- or high-intensity statin therapy for most adults aged 40-75 years with diabetes or LDL ≥70 mg/dL. For those without diabetes but with a CVD risk of 7.5% or higher, it recommends discussing statin therapy. The guidelines also provide recommendations for managing statin side effects, evaluating risk factors, and refining risk assessment using coronary artery calcium scoring. The main messages are to emphasize lifestyle changes, use high-intensity statins for high-risk patients, and consider patient risk
This document discusses guidelines for managing dyslipidemia with statins. It identifies 4 main groups that benefit from statin treatment based on their ASCVD risk: 1) those with clinical ASCVD, 2) those with LDL-C >190 mg/dL, 3) those with diabetes aged 40-75 with LDL-C 70-189 mg/dL, and 4) those aged 40-75 without clinical ASCVD or diabetes but with LDL-C 70-189 mg/dL and 10-year ASCVD risk >7.5%. The document reviews evidence that moderate- and high-intensity statin therapy lowers ASCVD risk across all baseline LDL-C levels above 70 mg/dL. It provides guidance on
1) Statins are highly effective in reducing LDL-C and cardiovascular risk, playing a cornerstone role in lipid management. They work by inhibiting HMG-CoA reductase.
2) Atorvastatin has been extensively studied in large trials and shown to significantly reduce major cardiovascular events when doses are increased from 10 mg to 80 mg.
3) Studies in India found that high dose atorvastatin (80 mg) was well tolerated and more effective at reducing LDL-C and hs-CRP than lower doses in ACS patients. However, many ACS patients in India were not receiving statins as recommended.
LDL Cholesterol Target :“ Lower the Better ”Arindam Pande
Lowering LDL cholesterol provides significant cardiovascular benefits and reduces risk, even in those with low baseline LDL levels or who achieve very low LDL levels with treatment. While residual risk remains even with intensive statin therapy to lower LDL well below current target levels, risk continues to decrease as LDL is further lowered. The lower the achieved LDL level, the lower the long-term risk of major cardiovascular events and atherosclerotic progression.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
#flozins
🫀DAPA 🆚placebo in HFpEF
Now we have a positive trial!
⬇️18% in CV☠️ death or
worsening HF among LVEF>40%
⬇️ 21%heart failure
💥Results same for LVEF> 60% 🆚LVEF<60%
Hypertension: New Concepts, Guidelines, and Clinical Management Hypertensio...MedicineAndFamily
This document summarizes guidelines for diagnosing and treating hypertension. It discusses the prevalence of hypertension and cardiovascular disease in the US population. It reviews risk factors for hypertension and cardiovascular events. It also summarizes findings from clinical trials demonstrating the benefits of treating hypertension, including reduced risks of stroke, heart failure, and myocardial infarction. Thiazide diuretics are recommended as first-line treatment based on their effectiveness and lower costs.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
This document summarizes guidelines for managing diabetes in cardiac patients from the American Diabetes Association in 2011. It discusses studies that show intensive glucose control reduces cardiovascular outcomes for type 2 diabetes patients. However, the ACCORD trial found intensive control increased mortality, likely due to hypoglycemia. The ADA evidence grading system and criteria for diagnosing diabetes are also presented.
This document provides guidelines and recommendations for lipid management:
1. It summarizes the 2013 ACC/AHA guidelines and 2016 ACC expert consensus, focusing on proven therapy rather than arbitrary lipid targets. Lifestyle changes like diet and exercise are encouraged for all.
2. Statins are recommended for four major groups to reduce ASCVD risk. High, moderate, and low intensity statin therapies are defined based on average LDL-C reduction.
3. For patients who are truly statin intolerant or require additional lowering, the document provides guidance on use of non-statin therapies like ezetimibe, basing selection on risk level and comorbidities.
This document discusses glucose-lowering therapies and the clinical place of SGLT2 inhibitor agents. It presents the case of a 52-year-old male patient with type 2 diabetes, hypertension, and coronary artery disease. It analyzes adding empagliflozin or sitagliptin to the patient's current metformin regimen and reviews long-term trial data showing empagliflozin's superior effects on HbA1c reduction, weight loss, and hypoglycemia risk reduction compared to glimepiride. The document also discusses empagliflozin's benefits on blood pressure and potential cardioprotective mechanisms of action beyond glycemic control such as reducing cardiac fibrosis. It emphasizes the importance of individual
Dyslipidemia management an evidence based approachDr Vivek Baliga
In this presentation by Dr Vivek Baliga, he discusses the different available statins and how you can choose the right one in different clinical situations. See articles from Dr Baliga on http://drvivekbaliga.net
The document provides guidelines from a committee for managing blood cholesterol to reduce atherosclerotic cardiovascular disease risk. It includes 10 key recommendations, such as emphasizing lifestyle changes for all ages, using high-intensity statin therapy for patients with clinical ASCVD, considering additional nonstatin drugs for very high risk patients, and assessing adherence to medication and lifestyle changes. The guidelines cover measuring cholesterol levels, risk assessment, and treatment approaches for different patient groups including those with diabetes or severe hypercholesterolemia.
1. The new guidelines recommend initiating moderate or high-intensity statin therapy for patients in four categories based on their cardiovascular risk, rather than targeting a specific LDL-C level.
2. The four categories are: individuals with clinical atherosclerotic cardiovascular disease, LDL-C over 190 mg/dL, diabetes between ages 40-75 with LDL-C 70-189 mg/dL, and 10-year risk over 7.5% for ages 40-75 with LDL-C 70-189 mg/dL.
3. Lipids should be measured during follow-ups to assess adherence, not to achieve a specific target level.
1. Dyslipidemia is an important risk factor for cardiovascular disease and is defined by disorders of lipoprotein metabolism that result in high cholesterol, LDL, and triglycerides or low HDL.
2. Lifestyle changes and medications like statins are recommended to lower LDL levels and reduce cardiovascular risk, with lower LDL targets for those at highest risk.
3. Statins are the first-line treatment for lowering LDL but can cause side effects like muscle pain; newer drugs like PCSK9 inhibitors can further lower LDL in those unable to tolerate statins.
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
The American Heart Association and American College of Cardiology, in partnership with the National Heart, Lung and Blood Institute, have released new joint guidelines on cardiovascular disease prevention focusing on hyperlipidemia, hypertension, cardiovascular risk assessment, lifestyle interventions, and obesity. The guidelines provide recommendations on screening and treating dyslipidemia and cardiovascular risk through lifestyle modifications like diet, exercise, weight loss and smoking cessation as well as pharmacological interventions including statin therapy. The guidelines stratify treatment approaches based on levels of cardiovascular risk and recommend high or moderate intensity statins for primary and secondary prevention.
1) LDL-C levels are a major risk factor for acute coronary syndrome (ACS) and lowering LDL-C through intensive statin therapy leads to significant reductions in recurrent events and mortality after ACS.
2) Guidelines recommend initiating high-dose statins early for ACS patients and achieving an LDL-C reduction of at least 50% from baseline and an LDL-C level below 55 mg/dL to reduce risk.
3) Studies show high-dose rosuvastatin preloading before percutaneous coronary intervention (PCI) significantly reduces major adverse cardiac events and peri-procedural myocardial injury compared to no preloading or lower statin doses.
This document summarizes the 2013 ACC-AHA guidelines for cholesterol treatment. It outlines an algorithm for screening and statin treatment based on cardiovascular risk factors and LDL cholesterol levels. For those between 40-75 years old, it recommends either moderate or high-intensity statin therapy depending on calculated 10-year risk of atherosclerotic cardiovascular disease. High-intensity statin therapy is recommended for those with clinical atherosclerotic CVD or LDL cholesterol over 190 mg/dl. The guidelines also provide definitions of moderate and high-intensity statin regimens and a link to the risk calculator. Limitations noted are that risk factors like family history are not considered and those under 21 or over 75 without disease are not addressed.
The document outlines guidelines from the 2018 ACC/AHA for statin management in high-risk groups. It recommends high or moderate-intensity statins for four groups: patients with clinical atherosclerotic cardiovascular disease (ASCVD), primary prevention patients with LDL-C ≥190 mg/dL, primary prevention patients with diabetes and LDL-C 70-189 mg/dL, and high-risk patients without a 10-year ASCVD risk calculation. It provides specific statin treatment recommendations for each group based on age and risk factors. The guidelines also discuss monitoring response to statins and evaluating for drug interactions.
The document summarizes the 2013 ACC/AHA blood cholesterol treatment guidelines. The guidelines aim to reduce atherosclerotic cardiovascular disease risk based on evidence from statin randomized controlled trials. The guidelines recommend a patient-centered approach and emphasize that high- and moderate-intensity statin therapy provides the greatest reduction in risk across all baseline LDL-C levels. Primary prevention recommendations are based on estimated 10-year cardiovascular risk. The guidelines do not recommend targeting specific LDL-C levels but rather emphasize intensity of statin therapy.
The document discusses guidelines for managing dyslipidemia and cardiovascular disease risk, including:
1) It provides risk levels (very high, high, moderate, low) based on calculated cardiovascular risk and clinical factors and recommends LDL-C treatment targets for each level.
2) It discusses statin treatment for different risk levels, recommending the highest tolerated dose to reach LDL-C targets.
3) It summarizes trials comparing different statins and their average LDL-C reduction, finding some are more effective than others at reducing LDL-C.
This document discusses cardiovascular disease (CVD) prevention and treatment goals for dyslipidemia. It notes that CVD is a leading cause of death in Europe and prevention is important. The importance of lifestyle modifications and controlling risk factors like lipids and blood pressure is emphasized. Treatment goals for low-density lipoprotein cholesterol (LDL-C) are personalized based on a patient's risk level, ranging from less than 130 mg/dL for low risk to less than 55 mg/dL for extreme risk. Additional goals for high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoproteins, and triglycerides are provided. Compliance with statin therapy is important for achieving benefits.
This document discusses the role of statins in primary prevention of cardiovascular disease. It begins by outlining how cardiovascular disease is a leading cause of death worldwide. It then describes the pathogenesis of atherosclerosis and defines clinical forms of ASCVD. The main mechanisms of action and effects of statins on lipids are explained. The document recommends assessing cardiovascular risk and initiating statin therapy based on risk level. It also discusses risk-enhancing factors, adverse effects of statins, and contraindications. Guidelines from major cardiovascular organizations are referenced.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
- Studies have shown that lowering LDL cholesterol through statin therapy such as atorvastatin provides significant cardiovascular benefits in both primary and secondary prevention. Atorvastatin in particular has been shown in clinical trials to reduce cardiovascular events and mortality when used for acute coronary syndromes, stable coronary heart disease, and among those at high risk of cardiovascular disease. Atorvastatin may be a good choice of statin due to its proven efficacy in improving cardiovascular outcomes.
Diabetic patients are at high risk for cardiovascular disease due to dyslipidemia and should be treated aggressively to target lipid levels. Lifestyle modifications such as diet, exercise, and weight management are first-line treatment along with statin therapy. Statins should be prescribed to diabetic patients over age 40 with one or more other cardiovascular risk factors, or to those of any age with existing cardiovascular disease, to reduce LDL cholesterol. The main treatment goals are lowering LDL cholesterol to less than 100 mg/dL for patients without cardiovascular disease and less than 70 mg/dL for those with cardiovascular disease.
This document discusses cardiovascular disease risk factors and prevention strategies. It covers primary and secondary prevention. Key modifiable risk factors discussed include smoking, hypertension, hyperlipidemia, diabetes, obesity, physical inactivity, and diet. Prevention strategies focus on lifestyle modifications, risk factor control through medications if needed, and cardiac rehabilitation. Population-level interventions to reduce salt and saturated fat intake are also recommended.
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
The document discusses lipid abnormalities and cardiovascular risk in patients with insulin resistance and diabetes. It notes that lipid abnormalities affect all lipid fractions, characterized by elevated triglycerides, remnant lipoproteins, small dense LDL, and low HDL. Lifestyle modifications and medical therapies can help treat diabetic dyslipidemia and reduce cardiovascular risk. The guidelines recommend statin therapy along with lifestyle changes to lower LDL and reduce risk, and address other lipid abnormalities as needed.
2013 ACC/AHA guidelines for blood cholesterol managementPraveen Nagula
The 2013 ACC/AHA blood cholesterol treatment guidelines focus on reducing atherosclerotic cardiovascular disease (ASCVD) risk through statin therapy rather than targeting specific LDL-C levels. The guidelines are based on evidence from randomized controlled trials showing consistent ASCVD risk reduction from high- and moderate-intensity statin regimens. They recommend a patient-centered approach and starting statins based on estimated 10-year ASCVD risk rather than using non-HDL or other targets. While lifestyle changes remain important, the guidelines emphasize intensity of statin therapy over addition of nonstatin drugs or targeting specific lipid levels.
This presentation by Nathaniel Lane, Associate Professor in Economics at Oxford University, was made during the discussion “Pro-competitive Industrial Policy” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/pcip.
This presentation was uploaded with the author’s consent.
This presentation by Tim Capel, Director of the UK Information Commissioner’s Office Legal Service, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
The importance of sustainable and efficient computational practices in artificial intelligence (AI) and deep learning has become increasingly critical. This webinar focuses on the intersection of sustainability and AI, highlighting the significance of energy-efficient deep learning, innovative randomization techniques in neural networks, the potential of reservoir computing, and the cutting-edge realm of neuromorphic computing. This webinar aims to connect theoretical knowledge with practical applications and provide insights into how these innovative approaches can lead to more robust, efficient, and environmentally conscious AI systems.
Webinar Speaker: Prof. Claudio Gallicchio, Assistant Professor, University of Pisa
Claudio Gallicchio is an Assistant Professor at the Department of Computer Science of the University of Pisa, Italy. His research involves merging concepts from Deep Learning, Dynamical Systems, and Randomized Neural Systems, and he has co-authored over 100 scientific publications on the subject. He is the founder of the IEEE CIS Task Force on Reservoir Computing, and the co-founder and chair of the IEEE Task Force on Randomization-based Neural Networks and Learning Systems. He is an associate editor of IEEE Transactions on Neural Networks and Learning Systems (TNNLS).
This presentation by Professor Giuseppe Colangelo, Jean Monnet Professor of European Innovation Policy, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
Why Psychological Safety Matters for Software Teams - ACE 2024 - Ben Linders.pdfBen Linders
Psychological safety in teams is important; team members must feel safe and able to communicate and collaborate effectively to deliver value. It’s also necessary to build long-lasting teams since things will happen and relationships will be strained.
But, how safe is a team? How can we determine if there are any factors that make the team unsafe or have an impact on the team’s culture?
In this mini-workshop, we’ll play games for psychological safety and team culture utilizing a deck of coaching cards, The Psychological Safety Cards. We will learn how to use gamification to gain a better understanding of what’s going on in teams. Individuals share what they have learned from working in teams, what has impacted the team’s safety and culture, and what has led to positive change.
Different game formats will be played in groups in parallel. Examples are an ice-breaker to get people talking about psychological safety, a constellation where people take positions about aspects of psychological safety in their team or organization, and collaborative card games where people work together to create an environment that fosters psychological safety.
1.) Introduction
Our Movement is not new; it is the same as it was for Freedom, Justice, and Equality since we were labeled as slaves. However, this movement at its core must entail economics.
2.) Historical Context
This is the same movement because none of the previous movements, such as boycotts, were ever completed. For some, maybe, but for the most part, it’s just a place to keep your stable until you’re ready to assimilate them into your system. The rest of the crabs are left in the world’s worst parts, begging for scraps.
3.) Economic Empowerment
Our Movement aims to show that it is indeed possible for the less fortunate to establish their economic system. Everyone else – Caucasian, Asian, Mexican, Israeli, Jews, etc. – has their systems, and they all set up and usurp money from the less fortunate. So, the less fortunate buy from every one of them, yet none of them buy from the less fortunate. Moreover, the less fortunate really don’t have anything to sell.
4.) Collaboration with Organizations
Our Movement will demonstrate how organizations such as the National Association for the Advancement of Colored People, National Urban League, Black Lives Matter, and others can assist in creating a much more indestructible Black Wall Street.
5.) Vision for the Future
Our Movement will not settle for less than those who came before us and stopped before the rights were equal. The economy, jobs, healthcare, education, housing, incarceration – everything is unfair, and what isn’t is rigged for the less fortunate to fail, as evidenced in society.
6.) Call to Action
Our movement has started and implemented everything needed for the advancement of the economic system. There are positions for only those who understand the importance of this movement, as failure to address it will continue the degradation of the people deemed less fortunate.
No, this isn’t Noah’s Ark, nor am I a Prophet. I’m just a man who wrote a couple of books, created a magnificent website: http://www.thearkproject.llc, and who truly hopes to try and initiate a truly sustainable economic system for deprived people. We may not all have the same beliefs, but if our methods are tried, tested, and proven, we can come together and help others. My website: http://www.thearkproject.llc is very informative and considerably controversial. Please check it out, and if you are afraid, leave immediately; it’s no place for cowards. The last Prophet said: “Whoever among you sees an evil action, then let him change it with his hand [by taking action]; if he cannot, then with his tongue [by speaking out]; and if he cannot, then, with his heart – and that is the weakest of faith.” [Sahih Muslim] If we all, or even some of us, did this, there would be significant change. We are able to witness it on small and grand scales, for example, from climate control to business partnerships. I encourage, invite, and challenge you all to support me by visiting my website.
This presentation by Juraj Čorba, Chair of OECD Working Party on Artificial Intelligence Governance (AIGO), was made during the discussion “Artificial Intelligence, Data and Competition” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/aicomp.
This presentation was uploaded with the author’s consent.
This presentation by OECD, OECD Secretariat, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
This presentation by Katharine Kemp, Associate Professor at the Faculty of Law & Justice at UNSW Sydney, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
This presentation by OECD, OECD Secretariat, was made during the discussion “The Intersection between Competition and Data Privacy” held at the 143rd meeting of the OECD Competition Committee on 13 June 2024. More papers and presentations on the topic can be found at oe.cd/ibcdp.
This presentation was uploaded with the author’s consent.
Carrer goals.pptx and their importance in real lifeartemacademy2
Career goals serve as a roadmap for individuals, guiding them toward achieving long-term professional aspirations and personal fulfillment. Establishing clear career goals enables professionals to focus their efforts on developing specific skills, gaining relevant experience, and making strategic decisions that align with their desired career trajectory. By setting both short-term and long-term objectives, individuals can systematically track their progress, make necessary adjustments, and stay motivated. Short-term goals often include acquiring new qualifications, mastering particular competencies, or securing a specific role, while long-term goals might encompass reaching executive positions, becoming industry experts, or launching entrepreneurial ventures.
Moreover, having well-defined career goals fosters a sense of purpose and direction, enhancing job satisfaction and overall productivity. It encourages continuous learning and adaptation, as professionals remain attuned to industry trends and evolving job market demands. Career goals also facilitate better time management and resource allocation, as individuals prioritize tasks and opportunities that advance their professional growth. In addition, articulating career goals can aid in networking and mentorship, as it allows individuals to communicate their aspirations clearly to potential mentors, colleagues, and employers, thereby opening doors to valuable guidance and support. Ultimately, career goals are integral to personal and professional development, driving individuals toward sustained success and fulfillment in their chosen fields.
XP 2024 presentation: A New Look to Leadershipsamililja
Presentation slides from XP2024 conference, Bolzano IT. The slides describe a new view to leadership and combines it with anthro-complexity (aka cynefin).
This presentation by Professor Alex Robson, Deputy Chair of Australia’s Productivity Commission, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
• For a full set of 530+ questions. Go to
https://skillcertpro.com/product/servicenow-cis-itsm-exam-questions/
• SkillCertPro offers detailed explanations to each question which helps to understand the concepts better.
• It is recommended to score above 85% in SkillCertPro exams before attempting a real exam.
• SkillCertPro updates exam questions every 2 weeks.
• You will get life time access and life time free updates
• SkillCertPro assures 100% pass guarantee in first attempt.
This presentation by OECD, OECD Secretariat, was made during the discussion “Pro-competitive Industrial Policy” held at the 143rd meeting of the OECD Competition Committee on 12 June 2024. More papers and presentations on the topic can be found at oe.cd/pcip.
This presentation was uploaded with the author’s consent.
2. Focus of Guidelines
• Primary and Secondary Atherosclerotic Cardiovascular Disease
(ASCVD) Prevention
• Four statin benefit groups:
Secondary ASCVD Prevention
Severe Hypercholesterolemia (LDL-C ≥190 mg/dL)
Diabetes Mellitus in Adults 40-75 Years of Age With LDL-
C 70-189 mg/dL
Primary Prevention Over the Life Span
• Importance of identifying Coronary Artery Calcium score( CAC
score)
3. ACC/AHA 2018 Cholesterol Guideline
High Blood Cholesterol and
Atherosclerotic CardiovascularDiseases
(ASCVD) Risk
4. LDL-C levels and high prevalence of
Cardiovascular Events
Journal of Clinical Lipidology (2014) 8, 29–60
5. ASCVD Risk classification
ASCVD Risk Risk category
Low risk <5%
Borderline risk 5% - <7.5%
Intermediate risk ≥7.5% to <20%
High risk ≥20%
J Am Coll Cardiol. 2018:1-80
6. Major Atherosclerotic Cardiovascular Disease
Risk Factors
Major risk factors Additional risk factors
Nontraditional risk
factors
Advancing age
⇧ Total serum cholesterol
level
⇧ Non–HDL-C
⇧ LDL-C
Low HDL-C
Diabetes mellitus
Hypertension
Stage 3 or 4 chronic
kidney disease
Cigarette smoking
Family history of ASCVD
Obesity, abdominal obesity
Family history of
hyperlipidemia
⇧ Small, dense LDL-C
⇧ Apo B
⇧ LDL particle concentration
Fasting/postprandial
hypertriglyceridemia
PCOS
Dyslipidemic triad
⇧ Lipoprotein (a)
⇧ Clotting factors
⇧ Inflammation
markers
(hsCRP; Lp-PLA2)
⇧ Homocysteine levels
Apo E4 isoform
⇧ Uric acid
⇧ TG-rich remnants
J Am Coll Cardiol. 2018:1-80
9. NCEP ATP III Updated Report:
LDL-C Goals Based on Risk Category
Grundy et al. Circulation.2004;110:227
10. The New 2018 ACC/AHA Cholesterol
Guidelines:
What is New
• LDL-C <70 mg/dl is required for very high risk ASCVD patients
• For patients with severe primary hypercholesterolemia,
achieve LDL-C <100 mg/dl with statins. Add Ezetimibe and/or
PCSK9 inhibitors if required
• Start moderate dose statin in diabetes patients without
measuring 10 years ASCVD risk
J Am Coll Cardiol. 2018:1-80
11. The New 2018 ACC/AHA Cholesterol
Guidelines:
What is New
• For 40-75 years, non-diabetic patients with LDL-C 70-189
mg/dl clinician patient discussion is required to start statin if
10 years ASCVD risk is >7.5%
• CAC (Coronary Artery Calcium Score) can help to take decision
on starting statin in primary prevention.
• Being South Asian is a risk enhancer for ASCVD, favors
initiation of statin therapy in non-diabetic patients for primary
prevention
J Am Coll Cardiol. 2018:1-80
12. High intensity statin therapy should be initiated as first line
therapy for 50% or greater LDL reduction
In patients whom high intensity statin therapy is contraindicated
or who experience statin associated side effects, moderate-
intensity statin therapy should be initiated for achieving a 30% to
49% reduction in LDL-C levels
Secondary ASCVD Prevention in Patients aged 75
years or younger with clinical ASCVD
J Am Coll Cardiol. 2018:1-80
13. In patients considered for PCSK9 inhibitor therapy, maximally
tolerated LDL-C lowering therapy should include maximally
tolerated statin therapy and ezetimibe
In patients who are on maximally tolerated LDL-C lowering
therapy with LDL-C 70 mg/dL or higher or a non-HDL-C level of
100 mg/dLor higher, it is reasonable to add a PCSK9 inhibitor
Secondary ASCVD Prevention in Patients aged 75
years or younger with clinical ASCVD
J Am Coll Cardiol. 2018:1-80
14. Patients on maximally tolerated statin therapy and are judged to
be at very high risk and have an LDL-C level of 70 mg/dL or
higher, it is reasonable to add ezetimibe therapy
Secondary ASCVD Prevention in Patients aged 75
years or younger with clinical ASCVD
J Am Coll Cardiol. 2018:1-80
15. Initiate moderate or high intensity statin therapy after
evaluation of the potential for ASCVD risk reduction
Patients who are tolerating high-intensity statin therapy, it is
reasonable to continue high-intensity statin therapy after
evaluation of the potential for ASCVD risk reduction
Secondary ASCVD Prevention in Patients aged 75
years or older with clinical ASCVD
J Am Coll Cardiol. 2018:1-80
16. Secondary ASCVD Prevention in Patients with
LDL-C> 70 mg/dL and clinical ASCVD
It may be reasonable to add ezetimibe in patients
receiving maximum tolerated statin dose
J Am Coll Cardiol. 2018:1-80
17. In patients with heart failure (HF) with reduced ejection
fraction attributable to ischemic heart disease who have a
reasonable life expectancy (3 to 5 years) and are not already on a
statin because of ASCVD, initiate moderate-intensity statin therapy
to reduce the occurrence of ASCVD events
Secondary ASCVD Prevention in Patients with
heart failure with reduced ejection fraction
J Am Coll Cardiol. 2018:1-80
22. Maximally tolerated statin therapy is recommended
Patients achieving less than 50% reduction in
LDL-C while receiving maximally tolerated statin therapy and/or
have an LDL-C level of 100 mg/dL or higher, ezetimibe
therapy is reasonable
Primary Severe Hypercholesterolemia in patients
aged 20-75 years with LDL-C ≥190 mg/dL
J Am Coll Cardiol. 2018:1-80
23. Patients achieving less than a 50% reduction
in LDL-C levels and have fasting triglycerides 300 mg/dL while taking
maximally tolerated statin and ezetimibe
therapy, the addition of a bile acid sequestrant may be considered
Primary Severe Hypercholesterolemia in patients
aged 20-75 years with LDL-C ≥190 mg/dL and
Triglycerides ≥ 300 mg/dL
J Am Coll Cardiol. 2018:1-80
24. In patients 30 to 75 years of age with heterozygous FH and with an
LDL-C level of 100 mg/dL or higher while taking
maximally tolerated statin and ezetimibe therapy, the addition of a
PCSK9 inhibitor may be considered
Primary Severe Hypercholesterolemia in patients
aged 30-75 years with LDL-C ≥100 mg/dL
J Am Coll Cardiol. 2018:1-80
25. Patients achieving an on-treatment LDL-C
level of 130 mg/dL or higher while receiving
maximally tolerated statin and ezetimibe therapy, the
addition of a PCSK9 inhibitor may be considered
Primary Severe Hypercholesterolemia in patients
aged 40-75 years with LDL-C ≥220 mg/dL
J Am Coll Cardiol. 2018:1-80
28. Initiate moderate intensity statin therapy regardless of
estimated 10 year ASCVD risk
In diabetes patients with LDL-C level of 70 to 189 mg/dL ,
it is reasonable to assess the 10 year risk of a first ASCVD
event
Diabetes Melitus in patients aged 40-75 years
J Am Coll Cardiol. 2018:1-80
29. Patients with multiple ASCVD risk factors, use high-intensity statin
therapy to reduce LDL-C levels by 50% or more
Patients with LDL-C level of 70 to 189 mg/dL , 10 year risk of a first
ASCVD event sholud be assessed
Diabetes Melitus in patients aged 75 yeras or
older
Patients with 10 year ASCVD risk of
20% or higher, add ezetimibe to maximally tolerated statin
therapy to reduce LDL-C levels by 50% or more
J Am Coll Cardiol. 2018:1-80
30. Initiate statin therapy in Diabetes patients with
•Long duration Diabetes (≥10 years of type 2 diabetes mellitus,
≥20 years of type 1 diabetes mellitus)
•Albuminuria (≥30 mcg of albumin/mg creatinine)
•eGFR less than 60 mL/min/1.73 m2
•Retinopathy,
•Neuropathy
•Ankle-brachial index (ABI <0.9)
Diabetes Melitus in patients aged 20-39 years
J Am Coll Cardiol. 2018:1-80
32. Risk Enhancing Factors for Clinician-Patient
Risk Discussion
J Am Coll Cardiol. 2018:1-80
33. In adults at intermediate risk , statin therapy reduces risk of
ASCVD. Use of moderate intensity statin is recommended
10 year ASCVD risk of a first ASCVD event (fatal and nonfatal MI
or stroke) should be estimated
Primary Prevention in Adults 40 to 75 Years
In intermediate or borderline risk adults, if the decision about
statin use remains uncertain, it is reasonable to use a Coronary
Artery Calcium (CAC) score to initiate statin
J Am Coll Cardiol. 2018:1-80
LDL-C Levels 70 to 189 mg/dL and without Diabetes
34. Primary Prevention in Adults 40 to 75 Years
CAC Score Statin Use
0 Withhold statin therapy, unless diabetes, family
history of premature CHD, or cigarette smoking are
present
Reassess in 5 to 10 years
1-99 Favors statin (especially after age 55)
100+ and/or 75th
percentile
Initiate statin therapy
J Am Coll Cardiol. 2018:1-80
LDL-C Levels 70 to 189 mg/dL and without Diabetes
35. Levels of CAC score indicating 75th percentile
for age, sex, and race/ethnicity
J Am Coll Cardiol. 2018:1-80
36. Candidates for Coronary Artery Calcium
Measurement Who Might Benefit from Knowing
CAC Score is Zero
J Am Coll Cardiol. 2018:1-80
41. Initiate a moderate intensity statin may be reasonable
Stop statin therapy when functional decline (physical or cognitive),
multimorbidity, frailty, or reduced life-expectancy limits the
potential benefits of statin therapy
Primary Prevention in Older Adults of age 75
years or more With LDL-C Levels 70 to 189 mg/dL
J Am Coll Cardiol. 2018:1-80
42. Measure CAC to reclassify those with a CAC score of zero
to avoid statin therapy
Primary Prevention in Older Adults of age 76-80
years
J Am Coll Cardiol. 2018:1-80
With LDL-C Levels 70 to 189 mg/dL
43. Initiate a moderate intensity statin may be reasonable
Stop statin therapy when functional decline (physical or cognitive),
multimorbidity, frailty, or reduced life-expectancy limits the
potential benefits of statin therapy
Primary Prevention in Children and Adolescents of
10 years of age or older
Measure fasting lipid profile to detect lipid disorders as
components of the metabolic syndrome as early as age 2 years to
detect Familial Hypercholesteremia or rare forms of
hypercholesterolemia
J Am Coll Cardiol. 2018:1-80
LDL-C level >190 mg/dL >160 mg/dL
44. In children and adolescents without cardiovascular risk factors or
family history of early CVD,measure a fasting lipid profile or
nonfasting non HDL-C once between the ages of 9 and 11 years,
and again between the ages of 17 and 21 years, to detect
moderate to severe lipid abnormalities
Primary Prevention in Children and Adolescents of
10 years of age or older
J Am Coll Cardiol. 2018:1-80
LDL-C level >190 mg/dL >160 mg/dL
46. Treat lifestyle factors (obesity and metabolic syndrome),
secondary factors (diabetes mellitus, chronic liver or kidney
disease and/or nephrotic syndrome, hypothyroidism)
Hypertriglyceridemia in adults 20 years or older
J Am Coll Cardiol. 2018:1-80
Triglycerides 175 to 499 mg/dL
47. Address reversible causes of high triglyceride and to initiate statin
therapy
Hypertriglyceridemia in adults 40 to 75 years
J Am Coll Cardiol. 2018:1-80
Triglycerides ≥500 mg/dL and ASCVD risk of 7.5% or higher
48. Hypertriglyceridemia in adults with 40 to 75
years
If triglycerides are persistently elevated or increasing , reduce
triglycerides by implementation of a very low fat diet, avoidance
of refined carbohydrates and alcohol, consumption of omega-3
fatty acids, and, if necessary to prevent acute pancreatitis,
fibrate therapy
J Am Coll Cardiol. 2018:1-80
Triglycerides ≥1000 mg/dL and ASCVD risk of 7.5% or higher
49. Patients not treated with dialysis or kidney transplantation
initiation of a moderate-intensity statin or moderate-intensity
statins combined with ezetimibe can be useful
Adults 40 to 75 years of age
Continue statin therapy in adults with advanced kidney disease
requiring dialysis treatment who are currently on LDL-lowering
therapy with a statin
J Am Coll Cardiol. 2018:1-80
With LDL-C 70 to 189 mg/dL who are at 10-year ASCVD risk of 7.5% or
higher and Chronic Kidney Disease
50. Moderate-intensity statin therapy or high-intensity statin therapy
should be given
Adults 40 to 75 years of age
In adults with Rheumatois Arthritis , it can be useful to recheck
lipid values and other major ASCVD risk factors 2 to 4 months after
the patient’s inflammatory disease has been controlled
J Am Coll Cardiol. 2018:1-80
With LDL-C 70 to 189 mg/dL who are at 10-year ASCVD risk of 7.5% or
higher and Chronic Inflammatory disorder and HIV
52. Focus on PersonalizedTreatment Goal
• In all individuals, emphasize a heart healthy lifestyle across
the life course
• In patients with clinical ASCVD, reduce LDL-C with high-
intensity statin therapy or maximally tolerated statin therapy
• Use non statin therapy like ezetemibe or PCSK9 inhibitors in
very hig risk ASCVDand use a LDL-C threshold of 70 mg/dL
• In patients with severe primary hypercholesterolemia (LDL-C
level ≥ 190 mg/dLwithout calculating 10-year ASCVD
risk,begin high-intensity statin therapy without calculating
10-year ASCVD risk
53. Focus on Personalized Treatment Goal
• In adults 40 to 75 years of age evaluated for primary ASCVD
prevention, have a clinician patient risk discussion before
starting statin therapy.
• In adults 40 to 75 years of age without diabetes mellitus and
with LDL-C levels ≥70 mg/dL , at a 10-year ASCVD risk of
≥7.5%, start a moderate intensity statin if a discussion of
treatment options favors statin therapy.
• In adults 40 to 75 years of age without diabetes mellitus and
10 year risk of 7.5%-19.9%, risk enhancing factors favor
initiation of statin therapy.
54. Focus on Personalized Treatment Goal
• In adults 40 to 75 years of age without diabetes mellitus and
with LDL-C levels ≥70 mg/dL 189 mg/dL, at a 10-year ASCVD
risk of ≥7.5%- 19.9%, if a decision about statin therapy is
uncertain, consider measuring coronary artery calcium (CAC)
• Assess adherence and percentage response to LDL-C lowering
medications and lifestyle changes with repeat lipid
measurement 4 to 12 weeks after statin initiation or dose
adjustment, repeated every 3 to 12 months as needed