Mount Carmel Health Partners Clinical Guidelines Hyperlipidemia

Hyperlipidemia Clinical Guideline
Definition: Hyperlipidemia is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood.
Atherosclerotic Cardiovascular Disease (ASCVD) Statin Benefit Groups
Heart-healthy lifestyle habits are the foundation of ASCVD prevention. In individuals not receiving cholesterol-lowering drug therapy, recalculate
estimated 10-year ASCVD risk every 4 - 6 years in those ages 40 - 75 years without clinical ASCVD or diabetes and with LDL-C 70 - 189 mg/dL.

Yes
Adults age > 20 years and a
candidate for statin therapy

Yes

Clinical
ASCVD
Yes

Definitions of High- and Moderate-intensity
Statin Therapy (see Table A)
High
Daily dose lowers
LDL-C by ≥ 50%

Moderate
Daily dose lowers LDL-C
by 30% to < 50%

Age ≤ 75 years
High-intensity statin (moderateintensity statin if not candidate for
high-intensity statin)
Age > 75 years OR not
candidate for high-intensity statin
Moderate-intensity statin

No

LDL-C
≥ 190
mg/dL

Yes

High-intensity statin
(moderate-intensity statin if not
candidate for high-intensity statin)

Follow-up
 Patients with a normal lipid profile should be screened

annually and encouraged to maintain a healthy lifestyle.

No

 Before initiation of statin therapy, FDA recommends Liver

Function Testing (LFT) with repeat testing only if clinically
indicated. Creatine Kinase (CK) level not recommended
prior to treatment or routinely during treatment.
 For patients who develop myalgia, CK level should be

measured. If levels exceed 3-5 times the upper limit of
normal (unrelated to unusual or excessive exercise),
consider dose reduction or temporarily stopping statin
therapy. Once muscle symptoms resolve, >90% of patients
will tolerate resuming the same or a different statin.

Moderate-intensity statin
No

Diabetes
Type 1 or 2
age 40 - 75

Yes

Estimated 10-year ASCVD risk ≥ 7.5%
Yes

Treat with a high-intensity statin
No

 Patients who achieve treatment goals with lifestyle

modifications should have a Fasting Lipid Profile (FLP) every
6-12 months to ensure compliance. After two consecutive
normal results, monitor annually.

Estimate 10-year ASCVD Risk
with Pooled Cohort Equations

 For patients who have failed to tolerate statin treatment,

manage with aggressive lifestyle modification and other
alternatives.
 Patients who do not achieve treatment goals despite drug

therapy and lifestyle modifications, consider specialist
referral including lipid specialist and registered dietitian/
nutritionist.

≥ 7.5%
estimated
10-year risk
and age 40-75

Yes

Moderate-to-high intensity statin

 Discontinue statins immediately if pregnant or 3 months

prior if trying to conceive.
No
ASCVD prevention benefit of statin therapy may be less clear in other groups. In selected individuals, consider additional factors influencing
ASCVD risk ‡ and potential ASCVD risk benefits and adverse effects, drug-drug interactions, and patient preferences for statin treatment.

August 2016