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Lipid Screening and Management in Adults [2014 update]

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Step Status
Educational Materials
Posttest
Evaluation
Release Date: Wed, 1/1/20
Termination Date: Mon, 8/31/20
Credits: 1
Description: Studies demonstrate that lipid management is effective and cost-effective for secondary prevention and in some circumstances for primary prevention of coronary heart disease (CHD) and athlerosclerotic cardiovascular disease (ASCVD). This self-study activity provides practical guidance for clinicians to understand and implement appropriate about screening and management of lipids, including detailed information regarding:
  • Screening guidelines
  • Assessing ASCVD risk
  • For those with no ASCVD or low risk for it, reinforce healthy lifestyle
  • For those with ASCVD or meaningful risk for it, treatment guidelines for lifestyle changes, statin therapy, and follow up. (Note: chronic kidney disease is addressed separately in the UMHS clinical guideline on that topic.)

New information in this updated guideline includes:

  • Change in treatment strategy: moving from previous "treat to target" approach to now focusing on using appropriate intensity statin therapy based on ASCVD risk level
  • Dosing for LDL-C reduction: high-intensity statin (≥ 50% LDL-C reduction), moderate-intensity statin (30%-50% LDL-C reduction).
    • Clinical ASCVD: age ≤ 75 yrs = high-intensity; age > 75 yrs = moderate-intensity
    • LDL-C ≥ 190 mg/dL, age ≥ 21 = high-intensity
    • Diabetes (type 1 or 2) and age 40-75 yrs with LDL-C 70-189 mg/dL = moderate-intensity; can consider high-intensity if 10-year ASCVD risk ≥ 7.5% (expert opinion)
    • 10-year ASCVD risk ≥ 7.5% and age 40-75 yrs with LDL-C 70-189 mg/dL, without DM, without clinical ASCVD = moderate-to-high intensity
  • Screening and monitoring:
    • Obtain a screening lipid profile, either fasting or, for patient convenience, non-fasting to facilitate obtaining data. Abnormal non-fasting screening lipids can go on to have a fasting lipid panel.
    • Monitor with annual lipid profile in order to assess for adherence (rather than to adjust statin dose).

Key aspects of care include:
  • Lipid management is effective and cost-effective for secondary prevention and in some circumstances for primary prevention.
  • Lifestyle modification is a critical component of health promotion and ASCVD risk reduction in both primary and secondary prevention.
  • Secondary prevention reduces mortality and CHD/atherosclerotic cardiovascular disease endpoints. All secondary prevention patients should be considered for drug therapy.
  • Primary prevention using lifestyle modifications and, if needed, drug therapy is targeted to patients' individual risk levels.
Educational Objectives: Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for lipid screening, identifying patients who would benefit from treatment, and recommending appropriate treatment regimens in adults 20-79 years of age.
Target Audience: This self-study activity is appropriate for primary care clinicians and other health care providers who screen and manage lipids in adults.
Accreditation Information: The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Release Date: May 2014

Termination Date: August 2020



Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in September 2017, and availability of CME credit continued.


Additional Info: Authors:
Audrey L. Fan, MD; General Medicine
Jill N. Fenske, MD; Family Medicine
R. Van Harrison, PhD; Medical Education
Elizabeth A. Jackson, MD; Cardiology
Marie A. Marcelino, PharmD; Pharmacy Services

Financial Disclosure Information:
Elizabeth A. Jackson, MD
Consultant: Pfizer

There are no other relevant financial relationships to disclose for this CME activity.

UMHS Guidelines Oversight Team:
Grant Greenberg, MD, MA, MHSA
R. Van Harrison, PhD

Literature Search Services:
Taubman Medical Library

Credits available:

AMA PRA Category 1: 1.00
Participation: 1.00