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What are the major risk factors used to individualize LDL Cholesterol goals?
- C-H-O-L-E
- Cigarette smoking
- Hypertension (blood pressure ≥140/90 mm Hg or taking antihypertensive medication)
- Older age (men ≥45 y; women ≥55 y)
- Low HDL cholesterol (<40 mg/dL [1.04 mmol/L])
- Elder (family) history of premature coronary artery disease (male first-degree relative age <55 y; female first-degree relative age <65 y)
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High risk: CAD or CAD equivalentsb (10-year risk >20%)
What is the cholesterol goal?
When do you initiate TLC (therapeutic lifestyle changes)?
When do you consider drug therapy?
bCAD risk equivalents include peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease, transient ischemic attacks or stroke of carotid origin or 50% obstruction of a carotid artery, diabetes, and 10-year risk for CAD ≥20%.
- LDL Cholesterol Goal is < 100 mg/dL
- Initiate TLC when LDL ≥ 100 mg/dL
- Consider Drug Therapy ≥ 130 mg/dL
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Moderately high risk: ≥2 risk factors (10-year risk 10% to 20%)
1. What is the cholesterol goal?
2. When do you initiate TLC (therapeutic lifestyle changes)?
3. When do you consider drug therapy?
- 1. <130 mg/dL
- 2. ≥130 mg/dL
- 3. ≥130 mg/dL
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Moderate risk: ≥2 risk factors (10-year risk <10%)
1. What is the cholesterol goal?
2. When do you initiate TLC (therapeutic lifestyle changes)?
3. When do you consider drug therapy?
- 1. <130 mg/dL
- 2. ≥130 mg/dL
- 3. ≥160 mg/dL
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Lower risk: 0 to 1 risk factor
1. What is the cholesterol goal?
2. When do you initiate TLC (therapeutic lifestyle changes)?
3. When do you consider drug therapy?
- 1. <160 mg/dL
- 2. ≥160 mg/dL
- 3. ≥190 mg/dL
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When do you treat treat triglyceride elevation?
The ATP III recommends treatment of moderate triglyceride elevation (200-499 mg/dL [2.26-5.64 mmol/L]) only if non–HDL cholesterol is elevated
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How do you calculate non-HDL cholesterol level, and what is its significance?
What is the pt's non-HDL cholesterol goal?
When do you treat moderate triglycerid elevation?
- Determining goal triglyceride level is an indirect process based on non–HDL cholesterol level (total cholesterol minus HDL cholesterol)
- This value, which comprises very-low-density lipoprotein (VLDL) and LDL cholesterol levels, is a good estimate of the level of atherogenic lipid particles and is a better estimate of CAD risk than LDL cholesterol alone.
- The non–HDL cholesterol goal equals the patient’s LDL cholesterol goal plus 30 mg/dL (0.78 mmol/L) (accounting for a top-normal VLDL cholesterol of 30 mg/dL [0.78 mmol/L]).
- The ATP III recommends treatment of moderate triglyceride elevation (200-499 mg/dL [2.26-5.64 mmol/L]) only if non–HDL cholesterol is elevated.
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