Professional Documents
Culture Documents
Treatment of
Hypercholesterolemia
Dr. Faris Abdul Kareem
FRCP
SAUDIA
The overall prevalence of dyslipidemia ranged
from about 20% to 40%.
The highest prevalence was for triglycerides
where about 44% of all subjects were affected.
20% of the subjects had high level of total
cholesterol.
Males had significantly higher prevalence of all
types of dyslipidemia than female except LDL-C
and TC.
IRAN
In 2006 in control and obese adoulcents
mean value (mg/dl)
% dyslipidemia
control obese
control obese
Choles 171
197
8%
22%
TG
108
148
14%
33%
LDL
102
121
4%
13%
Iraq
STEPS study (WHO+MOH)
The prevalence of high serum cholesterol
(5.2 mmol/L) was 37.5% being higher
among male than female. While in egypt it
was 19.4% and it was higher in females.
More than one fourth of the young adults
(age group 25-34 years) suffered from
hypercholesterolemia.
IRAQ
In diabetics with atherosclerosis 2008 basrah
(south)
68.7% of patients with hypercholesterolemia
21.5% with low levels of high density
lipoprotein cholesterol
84.1% with elevated low density lipoprotein
cholesterol
71.6% with hypertriglycerideemia
IRAQ
IRAQ
In mosul 2004 871 apparently healthy
volunteers (413 males, 458 females) aged
20-70 year ([mean +/- SD] 41.2 +/- 13.8 year)
Based on the American NCEP III criteria, the
dyslipidemic states;
high TG (41.6%)
high LDL-C (57.8%)
low HDL-C (49.9%)
high non-HDL-C (56.8%)
Guideline Scope
Focus on treatment of blood cholesterol to reduce
ASCVD risk in adults
Emphasize adherence to a heart healthy lifestyle as
foundation of ASCVD risk reduction
Lifestyle Management Guideline
Identify individuals most likely to benefit from
cholesterol-lowering therapy
4 statin benefit groups
Requires risk discussion between clinician and patient before statin initiation
Statin therapy may be considered if risk decision is uncertain after use of ASCVD
risk calculator
http://clincalc.com/Cardiology/ASCVD/PooledCohort.asp
*Individual responses to statin therapy varied in the RCTs and should be expected to vary in clinical practice.
There might be a biologic basis for a less-than-average response.
Evidence from 1 RCT only: down-titration if unable to tolerate atorvastatin 80 mg in IDEAL (Pedersen et al).
Although simvastatin 80 mg was evaluated in RCTs, initiation of simvastatin 80 mg or titration to 80 mg is
not recommended by the FDA due to the increased risk of myopathy, including rhabdomyolysis.
Monitoring Response-Adherence
(cont.)
Management of Muscle
Symptoms on Statin Therapy
It is reasonable to evaluate and treat muscle
symptoms including pain, cramping, weakness, or
fatigue in statin-treated patients according to the
management algorithm
To avoid unnecessary discontinuation of statins,
obtain a history of prior or current muscle symptoms
to establish a baseline before initiating statin therapy
Management of Muscle
Symptoms on Statin Therapy
(cont.)
If unexplained severe muscle symptoms or fatigue
develop during statin therapy:
Promptly discontinue the statin
Address possibility of rhabdomyolysis with:
CK
Creatinine
Urinalysis for myoglobinuria
Management of Muscle
Symptoms on Statin Therapy
(cont.)
If mild-to-moderate muscle symptoms develop during
statin therapy:
Discontinue the statin until the symptoms are
evaluated
Evaluate the patient for other conditions* that might
increase the risk for muscle symptoms
If after 2 months without statin Rx, muscle symptoms
or elevated CK levels do not resolve completely,
consider other causes of muscle symptoms
*Hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as
polymyalgia rheumatica, steroid myopathy, vitamin D deficiency or primary muscle diseases
Statin-Treated Individuals
Nonstatin Therapy
Considerations
Three Principles
Do not focus on LDL-C or nonHDL-C levels as
treatment goals
Although continue to obtain a lipid panel to
monitor adherence
Use medications proven to reduce ASCVD risk
Risk decisions in primary prevention require a
clinician-patient discussion to evaluate the benefits
and harms for the individual patient
Optimal lifestyle emphasized
Clinician-patient discussion needed for
appropriate shared decision-making
STATIN Safety
recommendations
conditions that could predispose pts to statin
side effect:
o
o
o
o
o
o
STATIN Safety
recommendations
Case 1
62 year old AA male
Total cholesterol: 140
Low HDL: 35
SBP: 130 mmHg
Not taking anti-hypertensive medications
Non-diabetic
Non-smoker
Calculated 10 yr risk of ASCVD : 9.1%
Case 2
50 year old white female
Total cholesterol 180
HDL: 50
SBP: 130
taking anti-hTN meds
+diabetic
+smoker
Calculated 10 yr ASCVD: 9.8%
Case 3
48 yo white female
Total cholesterol 180
HDL: 55
SBP: 130
Not taking anti-hTN meds
+diabetic
Non-smoker
Calculated 10 yr risk ASCVD : 1.8%
Case 4
22 yo white male
LDL: 195
SBP: 120
Not taking anti-hTN meds
Non-diabetic
Non-smoker
Case 5
66 yo white female
High Total cholesterol: 230
HDL: 55
SBP: 150
taking anti-hTN meds
Non-diabetic
Non-smoker
Calculated 10 yr risk of ASCVD : 2.0 %
Thank you