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