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Content Update

March 5, 2020

New Triglyceride-Lowering Indications and Bempedoic Acid Approval for Dyslipidemia: The 2018 AHA/ACC Guideline on the Management of Blood Cholesterol included recommendations for treating severe hypertriglyceridemia but none for treating less severe triglyceride (TG) elevations. A recent trial (REDUCE-IT) demonstrated reduced cardiovascular (CV) events by treating patients with moderately elevated TGs with icosapent ethyl (IE) in patients with established clinical atherosclerotic cardiovascular disease (ASCVD) or diabetes mellitus with multiple CV risk factors. The Food and Drug Administration (FDA) approved IE for this indication. The FDA also approved bempedoic acid as an adjunct to diet and maximally tolerated statin therapy for treatment of adults with heterozygous familial hypercholesterolemia or established ASCVD who require additional lowering of low-density lipoprotein cholesterol (LDL-C).

Content Update

February 1, 2019

New Cholesterol Management Guidelines Emphasize Practicality and Clinical Judgment: The 2018 AHA/ACC Guideline on the Management of Blood Cholesterol reinforces the need to encourage lifestyle modification to prevent atherosclerotic cardiovascular disease (ASCVD) and to use high-potency statins in patients at high risk of major adverse cardiovascular (CV) events. LDL-C targets have been re-introduced into the guidelines. Combination therapy using a statin plus either ezetimibe or a PCSK-9 inhibitor should be considered in very high-risk patients who do not reach their LDL-C target. Clinicians and patients can now consider a wider array of risk-enhancing factors when making treatment decisions. Most patients no longer need to fast before obtaining a lipid profile.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify the common types of lipid disorders.

  2. Identify the statin-benefit groups and intensity of statin therapy according to the American College of Cardiology/American Heart Association.

  3. Recommend appropriate therapeutic lifestyle changes (TLC) and pharmacotherapy interventions for dyslipidemia.

  4. Determine a patient’s atherosclerotic cardiovascular disease risk and corresponding treatment goals according to the National Lipid Association, American Association of Clinical Endocrinologist/American College of Endocrinology, and American College of Cardiology.

  5. Identify patients who are indicated for nonstatin therapy according to the American College of Cardiology.

  6. Describe components of a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for dyslipidemias.

  7. Educate patients about the disease state, appropriate TLC, and drug therapy required for effective treatment.

INTRODUCTION

image Hypercholesterolemia or dyslipidemia play a major role in atherosclerosis and plaque formation leading to coronary heart disease (CHD) as well as other forms of atherosclerotic cardiovascular disease (ASCVD), such as carotid and peripheral artery disease.1 CHD is the leading cause of death in adults in the United States and most industrialized nations. It is also the chief cause of premature, permanent disability in the US workforce.

EPIDEMIOLOGY AND ETIOLOGY

It is estimated that 94.6 million US adults have high cholesterol with a value of 200 mg/dL ...

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