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Normal Cholesterol Levels
- TC < 200
- LDL <100
- HDL > 40 men, > 50 women
- TG <150
30 more than the LDL-C goal
Calculate by (TC - HDL-C = non-HDL-C)
1st line treatment for dyslipidemia
ATP III Risk Stratification for Dyslipidemia goals: Low risk (0-1 risk factor)
LDL-C goal < 160
ATP III Risk Stratification for Dyslipidemia goals: Mod. risk (2+ risk factors)
If 10-year Framingham risk is < 10%:
LDL-C goal < 130
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
ATP III Risk Stratification for Dyslipidemia goals: High risk (3+, CHD, or CHD equivalent risk factor)
LDL-C goal <100, option <70
ATP III CHD risk equivalents
DM, Carotid artery disease, AAA, PVD/PAD, or Multiple risk factors (FRAS >20%)
ATP III Cholesterol Screening
Begin at age 20, q5y if normal. Annually if abnl.
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.
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)
Definition of Myopathy (in consideration of statin therapy)
c/o myalgia, weakness, cramps
+ CK >10x ULN
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)
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
"Rule of 6"
Expect 6% reduction in LDL-C with each doubling of statin dose.