TREATMENT OF CARDIOVASCULAR

DISEASE PATIENTS
C L I N I C A L A P P L I C AT I O N O F T R E AT M E N T G U I D E L I N E S
 OBJECTIVES

To present a case of a cardiovascular

disease patient.
To discuss treatment options and clinical
applications based on current guidelines
and clinical evidence
KH
Chief Investment Collector
BUWIS BUHAY Ent.
50 year old female
Filipino
Total cholesterol: 215
HDL: 55
LDL-C: 150
SBP: 150 mmHg
Not taking anti-HTN meds

Diabetic
KH
Chief Investment Collector
BUWIS BUHAY Ent.

Non-smoker
Non-alcoholic
BMI is 30kg/m2
PE: normal
The Intimate Connection
 Problems of Kimmy

High High
Lipids BP

DM2
 High CHOLESTEROL TREATMENT
LIPIDS GUIDELINES 2013

NHLBI and ACC/AHA Statement

First new guidelines since ATP III guideline
update in 2004
This guideline focuses on treatments to reduce
ASCVD events
 Atherosclerotic Cardiovascular
Disease(ASCVD)CTG2013

CAD PAD
STROKE
High
GOALS OF TREATMENT
LIPIDS

Goal: treatment of blood cholesterol to reduce

atherosclerotic cardiovascular risk in adults
 Healthy diet

High
Regular exercise
LIFESTYLE MODIFICATION
IMPORTANT
No tobacco

LIPIDS
Maintain healthy weight

Healthy diet
Regular exercise
No tobacco
Maintain healthy weight
ACC/AHA CV RISK
CALCULATOR
Based on 25,000 patients 50 AA F
in ARIC, Framingham, and
other cohorts
Includes stroke, not just MI
and death 215 55
Uses sex, age, race, total
C, HDL-C, systolic BP, and
treatment for HPN and DM 150 NO
and smoking

NO YES

3.6%

39%
High
GOALS OF TREATMENT
LIPIDS

Goal: treatment of blood cholesterol to reduce

atherosclerotic cardiovascular risk in adults

The focus of treatment has shifted from treating LDL-

cholesterol targets to prevention of events in four groups
of primary or secondary prevention patients considered
most likely to benefit from statin therapy
High
GOALS OF TREATMENT
LIPIDS
 High
Written
Financial STATIN BENEFIT GROUPS
LIPIDS
Plan

TREATMENT

Group 4
ASCVD risk >7%
Group 3 No diabetes
DM > Age 40-75 years
> Age 40-75 >LDL C:
Group 2 70-189mg/dl
>LDL C:
LDL C: 70-189mg/dl
Group 1 >190mg/dl
Clinical ASCVD
CHD, Stroke, PAD
Today
 INTENSITY OF STATIN THERAPY IN
PRIMARY AND SECONDARY PREVENTION
High-Intensity Statin Moderate-Intensity Low-Intensity Statin
Therapy Statin Therapy Therapy
Daily dose lowers LDLC Daily dose lowers LDLC Daily dose lowers LDLC
on average, by on average, by on average, by <30%
approximately 50% approximately 30% to
<50%

Atorvastatin (40)80 mg Atorvastatin 10 (20) mg Simvastatin 10 mg

Rosuvastatin 20 (40) mg Rosuvastatin (5) 10 mg Pravastatin 1020 mg
Simvastatin 2040 mg Lovastatin 20 mg
Pravastatin 40 (80) mg Fluvastatin 2040 mg
Lovastatin 40 mg Pitavastatin 1 mg
Fluvastatin XL 80 mg
Fluvastatin 40 mg bid
Pitavastatin 24 mg
 ASCVD STATIN BENEFIT GROUP 1:
SECONDARY PREVENTION

Adults with Clinical ASCVD

(candidates for statin therapy)
Age <75 years High-intensity Statin

Age >75 years or not a candidate Moderate-intensity Statin

for high intensity statin

Stone NJ, et al JACC 2013

 ASCVD STATIN BENEFIT GROUP 2:
PRIMARY PREVENTION LDL-C >190MG/DL

Adults with primary LDL-C >190mg/dL familial

hypercholesterolemia (candidates for statin therapy)
High-intensity statin If not a candidate for high-
intensity statin:
Moderate-tolerated statin

Stone NJ, et al JACC 2013

 ASCVD STATIN BENEFIT GROUP 3:
PRIMARY PREVENTION DIABETES

Adults aged 40-75 years with diabetes and LDL-C

70-189mg/dl (candidates for statin therapy)
Moderate-intensity If estimated 10-yr ASCVD risk >7.5%:
statin High-intensity statin

Stone NJ, et al JACC 2013

 ASCVD STATIN BENEFIT GROUP 4:
PRIMARY PREVENTION >7.5% 10-YR RISK,
NO DIABETES

Adults aged 40-75 years with LDL-C 70-189mg/dl and

estimated 10-yr CVD risk > 7.5%
(candidates for statin therapy)
Moderate to High-intensity Statin

Stone NJ, et al JACC 2013

 High
Written
Financial STATIN BENEFIT GROUPS
LIPIDS
Plan

TREATMENT

Group 4
Group 3 ASCVD risk >7%
Group 3 No diabetes
DM
DM > Age 40-75 years
> Age 40-75 >LDL C:
Group 2Age>LDL
40-75
C: 70-189mg/dl
LDL C: 70-189mg/dl
Group 1 LDL C: 70-189mg/dl
>190mg/dl
Clinical ASCVD
CHD, Stroke, PAD
Today
ACC/AHA CV RISK
CALCULATOR
50 AA F

215 55

150 NO

NO YES

3.6%

39%
High RECOMMENDATION BASED ON
LIPIDS ASCVD RISK CALCULATION

MODERATE INTENSITY STATIN Recommended

should be initiated or maintained for the patient
50 years of age with DM2 (IA)
evaluate patient for adverse events of the
treatment
consider patient preferences
DM 2 CHOICE OF STATIN

Moderate-Intensity Statin
evaluate patient for adverse Therapy
events of the treatment
Atorvastatin 10 (20) mg
Rosuvastatin (5) 10 mg
Simvastatin 2040 mg
Pravastatin 40 (80) mg
Lovastatin 40 mg
Fluvastatin XL 80 mg
Fluvastatin 40 mg bid
Pitavastatin 24 mg