Unstable angina / non ST elevation myocardial infarction lipid managment

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ACC / AHA Guidelines (DO NOT EDIT)

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Class I 1. The following lipid recommendations are beneficial: a. Lipid management should include assessment of a fasting lipid profile for all patients, within 24 h of hospitalization. (Level of Evidence: C) b. Hydroxymethyl glutaryl-coenzyme A reductase inhibitors (statins), in the absence of contraindications, regardless of baseline LDL-C and diet modification, should be given to post-UA / NSTEMI patients, including post revascularization patients. (Level of Evidence: A) c. For hospitalized patients, lipid-lowering medications should be initiated before discharge. (Level of Evidence: A) d. For UA / NSTEMI patients with elevated LDL-C (≥100 mg/dL), cholesterol lowering therapy should be initiated or intensified to achieve an LDL-C of <100 mg/dL. (Level of Evidence: A) Further titration to <70 mg/dL is reasonable (Class IIa, Level of Evidence: A) e. Therapeutic options to reduce non HDL-C are recommended, including more intense LDL-C lowering therapy. (Level of Evidence: B) f. Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), cholesterol (to <200 mg/d), and trans fat (to <1% of energy). (Level of Evidence: B) g. Promoting daily physical activity and weight management are recommended. (Level of Evidence: B) 2. Treatment of triglycerides and non-HDL-C is useful, including the following: a. If triglycerides are 200-499 mg/dL, non HDL-C should be <130 mg/dL. (Level of Evidence: B) b. If triglycerides are ≥500 mg/dL, therapeutic options to prevent pancreatitis are fibrate or niacin before LDL-lowering therapy is recommended. It is also recommended that LDL-C be treated to goal after triglyceride lowering therapy. Achievement of a non HDL-C <130 mg/dL (i.e., 30 mg/dL greater than LDL-C target) if possible is recommended. (Level of Evidence: C) Class IIa 1. The following lipid management strategies can be beneficial: a. Further reduction of LDL-C to <70 mg/dL is reasonable. (Level of Evidence: A) b. If baseline LDL cholesterol is 70-100 mg/dL, it is reasonable to treat LDL-C to less than 70 mg/dL. (Level of Evidence: B) c. Further reduction of non HDL-C to <100 mg/dL is reasonable; if triglycerides are 200 to 499 mg/dL, non HDL-C target is <130 mg/dL. (Level of Evidence: B) d. Therapeutic options to reduce non-HDL-C (after LDL-C lowering) include niacin or fibrate therapy. e. Nicotinic acid (niacin) and fibric acid derivatives (fenofibrate, gemfibrozil) can be useful as therapeutic options (after LDL-C– lowering therapy) for HDL-C <40 mg/dL. (Level of Evidence: B) f. Nicotinic acid (niacin) and fibric acid derivatives (fenofibrate, gemfibrozil) can be useful as therapeutic options (after LDL-C lowering therapy) for triglycerides >200 mg/dL. (Level of Evidence: B) g. The addition of plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) is reasonable to further lower LDL-C. (Level of Evidence: A) Class IIb 1. Encouraging consumption of omega-3 fatty acids in the form of fish or in capsule form (1 g per d) for risk reduction may be reasonable. For treatment of elevated triglycerides, higher doses (2 to 4 g per d) may be used for risk reduction. (Level of Evidence: B)

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Sources

• The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction