Dyslipidemia (ATPIII)

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Author:
wcameron
ID:
200342
Filename:
Dyslipidemia (ATPIII)
Updated:
2013-02-13 19:06:07
Tags:
Dyslipidemia guidelines
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Description:
NCEP ATP III Guidelines for Dyslipidemia
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  1. Normal Cholesterol Levels
    • TC < 200
    • LDL <100
    • HDL > 40 men, > 50 women
    • TG <150
  2. Non-HDL-C goal
    30 more than the LDL-C goal

    Calculate by (TC - HDL-C = non-HDL-C)
  3. 1st line treatment for dyslipidemia
    Statin therapy
  4. ATP III Risk Stratification for Dyslipidemia goals: Low risk (0-1 risk factor)
    LDL-C goal < 160
  5. ATP III Risk Stratification for Dyslipidemia goals: Mod. risk (2+ risk factors)
    If 10-year Framingham risk is < 10%:

    LDL-C goal < 130
  6. ATP III Risk Stratification for Dyslipidemia goals: Mod./High risk (2+ risk factors)
    If 10-yr. Framingham risk is 10-20%: 

    LDL-C goal <130, but <100 option
  7. ATP III Risk Stratification for Dyslipidemia goals: High risk (3+, CHD, or CHD equivalent risk factor)
    LDL-C goal <100, option <70
  8. ATP III CHD risk equivalents
    DM, Carotid artery disease, AAA, PVD/PAD, or Multiple risk factors (FRAS >20%)
  9. ATP III Cholesterol Screening
    Begin at age 20, q5y if normal. Annually if abnl.
  10. ATP III goals for cholesterol treatment
    Target LDL first, then non-HDL-C (which targets TG's). 

    * Unless TG's dangerously high (>500), then start with TG treatment.
  11. Framingham Traditional Risk Factors affecting LDL-C goals
    Smoking, Age (men >/= 45, women >/= 55), HTN (>/= 140/90 or on meds), low HDL-C, Fm Hx of premature CHD (male <55y, female <65y)
  12. Definition of Myopathy (in consideration of statin therapy)
    c/o myalgia, weakness, cramps

    +  CK >10x ULN
  13. Definition of rhabdomyolosis (in consideration of statin therapy)
    CK > 10,000 or > 10x ULN 

    +

    Increased creatinine or need for IV hydration

    OBTAIN BASELINE CK IN HIGH RISK PATIENTS (liver dz, renal dz, polypharmacy)
  14. Statins
    -statin

    lower LDL by 30-55%, Crestor best, then Lipitor

    Risk of myopathy/rhabdo./liver fx but no need for routine monitoring of LFT's once initiated. 

    Contraind. in pregnancy, concurrent liver dz
  15. "Rule of 6"
    Expect 6% reduction in LDL-C with each doubling of statin dose.

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