Lipid Screening and Management in Adults [2014 update]
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- 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.
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.
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
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