This document provides guidelines for statin therapy and the management of dyslipidemia. It discusses primary and secondary prevention with statins, adverse effects of statins including muscle symptoms and diabetes risk, and the roles of non-statin therapies like ezetimibe, fibrates, and omega-3 fatty acids. It also provides recommendations on monitoring lipids, liver enzymes, and creatine kinase in patients on lipid-lowering drugs. Testing frequencies are outlined, along with actions based on elevated biomarker levels. The guidelines aim to optimize cardiovascular risk reduction while safely managing drug therapies.
Targeting lipids: a primary and secondary care perspectiveInnovation Agency
Presentations by Dr Sue Kemsley and Dr Gavin Galasko from the first webinar of the Mastering Cholesterol webinar series on Thursday 26 January 2023, focusing on lipid management from a primary and secondary care perspective.
A detailed information about the cholesterol types, its absorption, conversion and drugs used to lower the levels of LDL, VLDL and Triglycerides - classification, mechanism of action, side effects, dosage and indications.
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
NON-ALCOHOLIC FATTY LIVER DISESEppt.pptxSangram Das
Always stay happy because with age beauty fades but inner charecter shines forever so always maintain your BMI and BMR also check fasting blood sugar every month.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Targeting lipids: a primary and secondary care perspectiveInnovation Agency
Presentations by Dr Sue Kemsley and Dr Gavin Galasko from the first webinar of the Mastering Cholesterol webinar series on Thursday 26 January 2023, focusing on lipid management from a primary and secondary care perspective.
A detailed information about the cholesterol types, its absorption, conversion and drugs used to lower the levels of LDL, VLDL and Triglycerides - classification, mechanism of action, side effects, dosage and indications.
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
NON-ALCOHOLIC FATTY LIVER DISESEppt.pptxSangram Das
Always stay happy because with age beauty fades but inner charecter shines forever so always maintain your BMI and BMR also check fasting blood sugar every month.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
6. ≥ 2 risk
factors
≥45 years
with LDL
≥130 mg/dL
02
01
Prevention in: Individuals with
no ASCVD Male sex
Postmenopausal
Smoker
HPN
Obesity (>25kg/m2)
Family history of CHD
LVH
Proteinuria
15. • For individuals with ACS, early high-
intensity statin that is maximally-tolerated
is RECOMMENDED and should not be
discontinued.
• Statins should be given to ACS patients
immediately
20. a. Statin-associated Muscle Symptoms
b. New-onset Diabetes
c. Dementia / cognitive dysfunction / intracerebral
hemorrhage
21. • Treatment with statins is associated
with a low risk of developing statin-
associated muscle symptoms (SAMS),
but the benefits of cardiovascular risk
reduction outweigh the risk
23. • Treatment with statins is associated
with an increased risk of new-onset
diabetes mellitus, but the benefits of
statin treatment for cardiovascular
risk reduction outweigh the risk.
24. • Treatment with statins is not
associated with the development of
dementia and cognitive dysfunction
• Treatment with statins is not
associated with an increased risk of
intracerebral hemorrhage
27. Ezetimibe
A cholesterol absorption inhibitor that
targets uptake at the jejunal enterocyte
brush border
Inhibits intestinal cholesterol
absorption by selectively blocking the
NPC1L1 protein in the jejunal brush
border, integral to the uptake of
intestinal lumen micelles into the
enterocyte
28. • For individuals with documented
ACS, and target LDL-C has not been
reached despite maximally tolerated
high-intensity statin therapy,
ezetimibe may be added on top of
statin therapy to get to goal LDL-C.
30. • Among individuals not at goal LDL-
C, routinely adding fibrates on top of
statin therapy is NOT
RECOMMENDED for primary or
secondary prevention of
cardiovascular disease.
31. However, adding fibrates to statins may
be considered among MEN with
controlled diabetes, low HDL-C (200
mg/dl) for prevention of CV disease.
32. Fibrates
Good efficacy in
lowering fasting
TG levels
≤20% reduction
of the LDL-C
level
50% reduction of
the TG level
increase of the
HDL-C level of
≤20%
33. Among individuals with ASCVD,
should omega fatty acids be
given on top of statin therapy
once LDL-C goal is achieved
34. • Among individuals with ASCVD,
omega fatty acids (EPA+DHA) given
on top of statin therapy is NOT
RECOMMENDED.
• Among individuals with ASCVD on
statin therapy at goal LDL-C, but
with persistently high triglyceride
levels of 150-499 mg/dl, omega fatty
acids (pure EPA) MAY be given
37. • Before starting lipid-
lowering drug
treatment, at least
two measurements
should be made, with
an interval of 1–12
weeks, with the
exception of
conditions where
prompt drug treatment
is suggested, such as
ACS and very high-
risk patients.
• After starting
treatment: 8 (±4)
weeks.
• After adjustment of
treatment: 8 (±4)
weeks until the goal is
achieved.
How often should lipids be
tested?
38. How often should lipids be tested
once a patient has achieved the
target or optimal lipid level?
Annually
39. How often should
liver enzymes (ALT)
be routinely
measured in patients
on lipid-lowering
drugs?
40. • Before treatment
• Once, 8–12 weeks
after starting a drug
treatment or after
dose increase.
• Routine control of
ALT thereafter is not
recommended during
statin treatment,
unless symptoms
suggesting liver
disease evolve.
• During treatment with
fibrates, control of
ALT is still
recommended.
How often should lipids be
tested?
41. What if liver enzymes
become elevated in a
person taking lipid-
lowering drugs?
42. Elevated ALT
ALT ≥3×
ULN
ALT <3× ULN
≥3×
<3×
• Continue therapy.
• Recheck liver enzymes in 4–6 weeks.
• Stop lipid-lowering therapy or reduce dose and
recheck liver enzymes within 4–6 weeks.
• Cautious reintroduction of therapy may be
considered after ALT has returned to normal.
• If ALT remains elevated check for the other
43. How often should CK be
measured in patients taking
lipid-lowering drugs?
44. Pre-treatment
• Before starting
therapy
• If baseline CK is
>4× ULN, do not
start drug therapy;
recheck
Monitoring
• Routine
monitoring of CK
is not necessary
• Check CK if
patient develops
myalgia
How often should CK be
measured in patients taking
lipid-lowering drugs?
45. CREDITS: This presentation template was created by Slidesgo,
including icons by Flaticon and infographics & images by
Freepik
THANK
YOU!
Please keep this slide for attribution
Editor's Notes
Before we proceed to discussing the clinical practice guidelines, let’s quickly review statins and their mechanism of action
Statins are also called HMG-CoA reductase inhibitors.
These drugs [click] increase hepatic LDL receptor activity [click] leading to increased circulating LDL clearance and [click] thereby, decrease the circulating levels of LDL in our plasma.
Statins also have side effects as all other drugs have and these will be discussed in the later parts of the report as part of the CPG.
We have this diagram that shows the [read title] [click ]
First and foremost, lifestyle modification would be our recommendation for patients who are at risk of developing atherosclerosis based on their history and physical exam.
However, there is a specific criteria with which we could add or start statin therapy to these patients.
In the primary prevention in individuals with no atherosclerotic cardiovascular diseases, the following criteria were given which could be bases to initiate statin therapy in Filipino patients
In the 2015 CPG, the authors have identified a Risk Factor Counting as the method in identifying the risks for developing cardiovascular problems in Filipino individuals
This method is being continuously recommended by the physicians for identification of CVD risk, as well as those needing medical therapy for primary prevention [press]
So, if these criteria or risk factors have been identified in patients, we could initiate statin therapy as early, on top of recommendations for lifestyle modification
Even without the presence of ASCVD or presence of risks for such, statin therapy must be initiated in patients with Diabetes Mellitus.
However, in the event of concomitant CV diseases in these individuals, there are target LDL levels that must be met for maintenance.
Statin doses given for patients with DM should be optimized to maintain the following LDL levels [click].
Maintaining these levels would be very useful for secondary prevention that which will be discussed later.
Familial hypercholesterolemia is a dominantly inherited gene disorder wherein mutations in the LDL-receptor pathway causes markedly elevated LDL levels from birth.
Untreated FH leads to premature death due to the early development of coronary artery disease in these patients secondary to accelerated atherosclerosis.
It is vital, therefore, that these patients should be identified early on and be started on statin therapy.
Since patient with FH are considered high-risk populations, they are started with high-dose intensity statins to maintain the following levels of LDL
Statins can be safely started on patients with CKD but those who are not on RRT or dialysis
Those who are on hemodialysis or those who have undergone kidney transplants, guidelines recommend referral to nephrologists for lipid management.
After the initiation of statins and after patient’s have been identified based on their CV risks, they can be re-assessed after 6-8 weeks. LDL levels can be evaluated after this given period of time to see if recommended LDL levels are maintained especially for those who are in high-risk groups.
