Hyperlipidemia Management Guidelines Summary PDF
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Uploaded by LightHeartedCerberus
Union University College of Pharmacy
Mark Stephens, PharmD, BCPS
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Summary
This document summarizes guidelines for hyperlipidemia management, outlining risk factors, lipid targets, and statin intensity recommendations. Data is drawn from multiple expert consensus pathways, highlighting different scenarios for cardiovascular disease risk reduction. The document emphasizes various therapies and considerations for patients with hyperlipidemia.
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**Summary of Hyperlipidemia Management Guidelines** ASCVD ASCVD w Very High Risk LDL ≥ 190 mg/dl Diabetes Diabetes with Risk No DM Borderline No DM Intermediate No DM High Risk 2018 AHA Multi-society Guideline on the Management of Blood Cholesterol. Circulation 2018;139:e1082-e1143 Risk factors...
**Summary of Hyperlipidemia Management Guidelines** ASCVD ASCVD w Very High Risk LDL ≥ 190 mg/dl Diabetes Diabetes with Risk No DM Borderline No DM Intermediate No DM High Risk 2018 AHA Multi-society Guideline on the Management of Blood Cholesterol. Circulation 2018;139:e1082-e1143 Risk factors ASCVD events and high-risk conditions Multiple risk factors or 10-Yr ≥ 20% If Risk Enhancing Factors (REF) 10-yr ≥ 7.5 < 20% ± REF 10-yr ≥ 20% Lipid targets LDL Non-HDL < 70 mg/dl < 100 mg/dl < 70 mg/dl < 100 mg/dl < 100 mg/dl ? ? ? ? ? Statin Intensity High High High Moderate High Moderate Moderate High if REF High 2nd line Ezetimibe Ezetimibe Ezetimibe Ezetimibe Ezetimibe 3rd line PCSK9 mAb BAS if TG < 300 mg/dl PCSK9 mAb if baseline LDL ≥ 220 mg/dl 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies of LDL Lowering in the Management of ASCVD Risk. J Am Coll Cardiol 2022;80:1366-1418 ASCVD ASCVD w Very High Risk LDL ≥ 190 mg/dl Diabetes Diabetes with Risk No DM Borderline No DM Intermediate No DM High Risk Risk factors ASCVD events and high-risk conditions 10-yr risk ≥ 7.5% Diabetes-specific risks 10-yr risk ≥ 20% Lipid targets LDL Non-HDL ≥ 50% LDL < 70 mg/dl < 100 mg/dl ≥ 50% LDL < 55 mg/dl§ < 85 mg/dl§ ≥ 50% LDL < 100 mg/dl < 130 mg/dl 30-49% LDL < 100 mg/dl < 130 mg/dl ≥ 50% LDL < 70 mg/dl < 100 mg/dl ≥ 50% LDL < 70 mg/dl < 100 mg/dl 30-49% LDL < 100 mg/dl 30-49% LDL < 100 mg/dl ≥ 50% LDL < 70 mg/dl Statin Intensity High High High Moderate High High Moderate Moderate High 2nd line Ezetimibe Ezetimibe and/or PCSK9 mAb Ezetimibe and/or PCSK9 mAb High-intensity statin Ezetimibe High-intensity statin High-intensity statin Ezetimibe 3rd line PCSK9 mAb added or replacing Bempedoic acid or Inclisiranⱡ Bempedoic acid or Inclisiranⱡ 4th line Bempedoic acid or Inclisiranⱡ Evinacumab 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients with Persistent Hypertriglyceridemia. J Am Coll Cardiol 2021;78:960-92. Persistent hypertriglyceridemia Icosapent ethyl* Icosapent ethyl* Icosapent ethyl* \* If ≥ 50 years old with ≥ 1 ASCVD risk factor (Men ≥ 55 yo, Women ≥ 65 yo; cigarette smoking or stopped within 3 months; hypertension (≥ 140/90) or on medications, HDL \< 40 mg/dl in men, \< 50 mg/dl in women; CRP \> 3.0; CrCl 30-60 ml/min; retinopathy, albuminuria, ABI \< 0.9 without symptoms. Risk factors from REDUCE-IT Trial.\ ^§^ 2023 ADA Guidelines recommend target for adult patients with diabetes and ASCVD\ ⱡ Avoid Inclisiran with PCSK9 mAb
