Coronary heart disease secondary prevention lipid management: Difference between revisions
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== Overview == | == Overview == | ||
== Lipid Management == | == Lipid Management == | ||
The goal is to successfully manage lipid levels, through statin therapy if necessary. Use statin therapy to achieve an LDL-C of <100 mg/dL; for very high risk patients an LDL-C <70 mg/dL is reasonable; if triglycerides are ≥200 mg/dL, non–HDL-C† should be <130 mg/dL, whereas non–HDL-C <100 mg/dL for very high risk patients is reasonable. | |||
== | |||
==2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) <ref name="pmid22052934">{{cite journal| author=Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA et al.| title=AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. | journal=Circulation | year= 2011 | volume= 124 | issue= 22 | pages= 2458-73 | pmid=22052934 | doi=10.1161/CIR.0b013e318235eb4d | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22052934 }} </ref>== | |||
===Lipid Management (DO NOT EDIT) <ref name="pmid22052934">{{cite journal| author=Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA et al.| title=AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. | journal=Circulation | year= 2011 | volume= 124 | issue= 22 | pages= 2458-73 | pmid=22052934 | doi=10.1161/CIR.0b013e318235eb4d | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22052934 }} </ref>=== | |||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A lipid profile in all patients should be established, and for hospitalized patients, lipid-lowering therapy as recommended below should be initiated before discharge. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A lipid profile in all patients should be established, and for hospitalized patients, lipid-lowering therapy as recommended below should be initiated before discharge. <ref name="pmid20082923">{{cite journal |author=Murphy SA, Cannon CP, Wiviott SD, McCabe CH, Braunwald E |title=Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial |journal=J. Am. Coll. Cardiol. |volume=54 |issue=25 |pages=2358–62 |year=2009 |month=December |pmid=20082923 |doi=10.1016/j.jacc.2009.10.005 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Lifestyle modifications including daily physical activity and weight management are strongly recommended for all patients. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Lifestyle modifications including daily physical activity and weight management are strongly recommended for all patients. <ref name="pmid1386186">{{cite journal |author=Dattilo AM, Kris-Etherton PM |title=Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis |journal=Am. J. Clin. Nutr. |volume=56 |issue=2 |pages=320–8 |year=1992 |month=August |pmid=1386186 |doi= |url=}}</ref><ref name="pmid12485966">{{cite journal |author= |title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report |journal=Circulation |volume=106 |issue=25 |pages=3143–421 |year=2002 |month=December |pmid=12485966 |doi= |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), transfatty acids (to <1% of total calories), and [[cholesterol]] (to <200 mg/d). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), transfatty acids (to <1% of total calories), and [[cholesterol]] (to <200 mg/d). <ref name="pmid9514413">{{cite journal |author=Ginsberg HN, Kris-Etherton P, Dennis B, ''et al.'' |title=Effects of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy subjects: the DELTA Study, protocol 1 |journal=Arterioscler. Thromb. Vasc. Biol. |volume=18 |issue=3 |pages=441–9 |year=1998 |month=March |pmid=9514413 |doi= |url=}}</ref><ref name="pmid9062535">{{cite journal |author=Schaefer EJ, Lamon-Fava S, Ausman LM, ''et al.'' |title=Individual variability in lipoprotein cholesterol response to National Cholesterol Education Program Step 2 diets |journal=Am. J. Clin. Nutr. |volume=65 |issue=3 |pages=823–30 |year=1997 |month=March |pmid=9062535 |doi= |url=}}</ref><ref name="pmid7627699">{{cite journal |author=Schaefer EJ, Lichtenstein AH, Lamon-Fava S, ''et al.'' |title=Efficacy of a National Cholesterol Education Program Step 2 diet in normolipidemic and hypercholesterolemic middle-aged and elderly men and women |journal=Arterioscler. Thromb. Vasc. Biol. |volume=15 |issue=8 |pages=1079–85 |year=1995 |month=August |pmid=7627699 |doi= |url=}}</ref><ref name="pmid10197564">{{cite journal |author=Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM |title=Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis |journal=Am. J. Clin. Nutr. |volume=69 |issue=4 |pages=632–46 |year=1999 |month=April |pmid=10197564 |doi= |url=}}</ref><ref name="pmid12485966">{{cite journal |author= |title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report |journal=Circulation |volume=106 |issue=25 |pages=3143–421 |year=2002 |month=December |pmid=12485966 |doi= |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' In addition to therapeutic lifestyle changes, [[statin]] therapy should be prescribed in the absence of [[contraindication]]s or documented adverse effects. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' In addition to therapeutic lifestyle changes, [[statin]] therapy should be prescribed in the absence of [[contraindication]]s or documented adverse effects. <ref name="pmid12114036">{{cite journal |author= |title=MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial |journal=Lancet |volume=360 |issue=9326 |pages=7–22 |year=2002 |month=July |pmid=12114036 |doi=10.1016/S0140-6736(02)09327-3 |url=}}</ref><ref name="pmid15755765">{{cite journal |author=LaRosa JC, Grundy SM, Waters DD, ''et al.'' |title=Intensive lipid lowering with atorvastatin in patients with stable coronary disease |journal=N. Engl. J. Med. |volume=352 |issue=14 |pages=1425–35 |year=2005 |month=April |pmid=15755765 |doi=10.1056/NEJMoa050461 |url=}}</ref><ref name="pmid16287954">{{cite journal |author=Pedersen TR, Faergeman O, Kastelein JJ, ''et al.'' |title=High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial |journal=JAMA |volume=294 |issue=19 |pages=2437–45 |year=2005 |month=November |pmid=16287954 |doi=10.1001/jama.294.19.2437 |url=}}</ref><ref name="pmid21067804">{{cite journal |author=Baigent C, Blackwell L, Emberson J, ''et al.'' |title=Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials |journal=Lancet |volume=376 |issue=9753 |pages=1670–81 |year=2010 |month=November |pmid=21067804 |pmc=2988224 |doi=10.1016/S0140-6736(10)61350-5 |url=}}</ref><ref name="pmid12485966">{{cite journal |author= |title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report |journal=Circulation |volume=106 |issue=25 |pages=3143–421 |year=2002 |month=December |pmid=12485966 |doi= |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: A'']])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' An adequate dose of statin should be used that reduces [[LDL-C]] to <100 mg/dL AND achieves at least a 30% lowering of [[LDL-C]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' An adequate dose of statin should be used that reduces [[LDL-C]] to <100 mg/dL AND achieves at least a 30% lowering of [[LDL-C]]. <ref name="pmid12114036">{{cite journal |author= |title=MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial |journal=Lancet |volume=360 |issue=9326 |pages=7–22 |year=2002 |month=July |pmid=12114036 |doi=10.1016/S0140-6736(02)09327-3 |url=}}</ref><ref name="pmid15755765">{{cite journal |author=LaRosa JC, Grundy SM, Waters DD, ''et al.'' |title=Intensive lipid lowering with atorvastatin in patients with stable coronary disease |journal=N. Engl. J. Med. |volume=352 |issue=14 |pages=1425–35 |year=2005 |month=April |pmid=15755765 |doi=10.1056/NEJMoa050461 |url=}}</ref><ref name="pmid16287954">{{cite journal |author=Pedersen TR, Faergeman O, Kastelein JJ, ''et al.'' |title=High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial |journal=JAMA |volume=294 |issue=19 |pages=2437–45 |year=2005 |month=November |pmid=16287954 |doi=10.1001/jama.294.19.2437 |url=}}</ref><ref name="pmid21067804">{{cite journal |author=Baigent C, Blackwell L, Emberson J, ''et al.'' |title=Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials |journal=Lancet |volume=376 |issue=9753 |pages=1670–81 |year=2010 |month=November |pmid=21067804 |pmc=2988224 |doi=10.1016/S0140-6736(10)61350-5 |url=}}</ref><ref name="pmid12485966">{{cite journal |author= |title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report |journal=Circulation |volume=106 |issue=25 |pages=3143–421 |year=2002 |month=December |pmid=12485966 |doi= |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Patients who have triglycerides ≥200 mg/dL should be treated with statins to lower non–[[HDL-C]] to <130 mg/dL. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Patients who have triglycerides ≥200 mg/dL should be treated with statins to lower non–[[HDL-C]] to <130 mg/dL. <ref name="pmid12114036">{{cite journal |author= |title=MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial |journal=Lancet |volume=360 |issue=9326 |pages=7–22 |year=2002 |month=July |pmid=12114036 |doi=10.1016/S0140-6736(02)09327-3 |url=}}</ref><ref name="pmid15755765">{{cite journal |author=LaRosa JC, Grundy SM, Waters DD, ''et al.'' |title=Intensive lipid lowering with atorvastatin in patients with stable coronary disease |journal=N. Engl. J. Med. |volume=352 |issue=14 |pages=1425–35 |year=2005 |month=April |pmid=15755765 |doi=10.1056/NEJMoa050461 |url=}}</ref><ref name="pmid16287954">{{cite journal |author=Pedersen TR, Faergeman O, Kastelein JJ, ''et al.'' |title=High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial |journal=JAMA |volume=294 |issue=19 |pages=2437–45 |year=2005 |month=November |pmid=16287954 |doi=10.1001/jama.294.19.2437 |url=}}</ref><ref name="pmid19161879">{{cite journal |author=Robinson JG, Wang S, Smith BJ, Jacobson TA |title=Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk |journal=J. Am. Coll. Cardiol. |volume=53 |issue=4 |pages=316–22 |year=2009 |month=January |pmid=19161879 |doi=10.1016/j.jacc.2008.10.024 |url=}}</ref> ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' Patients who have triglycerides >500 mg/dL should be started on [[fibrate]] therapy in addition to [[statin]] therapy to prevent [[acute pancreatitis]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' Patients who have triglycerides >500 mg/dL should be started on [[fibrate]] therapy in addition to [[statin]] therapy to prevent [[acute pancreatitis]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki> | ||
|} | |} | ||
| Line 30: | Line 34: | ||
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' If treatment with a [[statin]] (including trials of higher-dose [[statin]]s and higher-potency [[statin]]s) does not achieve the goal selected for a patient, intensification of [[LDL-C]]-lowering drug therapy with a [[bile acid sequestrant]] or [[niacin]] is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' If treatment with a [[statin]] (including trials of higher-dose [[statin]]s and higher-potency [[statin]]s) does not achieve the goal selected for a patient, intensification of [[LDL-C]]-lowering drug therapy with a [[bile acid sequestrant]] or [[niacin]] is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients who do not tolerate [[statin]]s, LDL-C–lowering therapy with [[bile acid sequestrant]]s and/or [[niacin]] is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients who do not tolerate [[statin]]s, LDL-C–lowering therapy with [[bile acid sequestrant]]s and/or [[niacin]] is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to treat very high-risk patients with [[statin]] therapy to lower LDL-C to <70 mg/dL. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to treat very high-risk patients with [[statin]] therapy to lower LDL-C to <70 mg/dL. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In patients who are at very high risk and who have [[triglyceride]]s ≥200 mg/dL, a non–HDL-C goal of <100 mg/dL is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In patients who are at very high risk and who have [[triglyceride]]s ≥200 mg/dL, a non–HDL-C goal of <100 mg/dL is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki> | ||
|} | |} | ||
| Line 43: | Line 47: | ||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''1.''' The use of [[ezetimibe]] may be considered for patients who do not tolerate or achieve target LDL-C with [[statin]]s, [[bile acid sequestrant]]s, and/or [[niacin]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]]) <nowiki>"</nowiki> | |bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''1.''' The use of [[ezetimibe]] may be considered for patients who do not tolerate or achieve target LDL-C with [[statin]]s, [[bile acid sequestrant]]s, and/or [[niacin]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence:C'']]) <nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients who continue to have an elevated non–HDL-C while on adequate [[statin]] therapy, [[niacin]] or [[fibrate]] therapy ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]]) or fish oil ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]]) may be reasonable. <nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients who continue to have an elevated non–HDL-C while on adequate [[statin]] therapy, [[niacin]] or [[fibrate]] therapy ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]]) or fish oil ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence:C'']]) may be reasonable. <nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' For all patients, it may be reasonable to recommend [[omega-3]] fatty acids from fish or fish oil capsules (1 g/d) for cardiovascular disease risk reduction. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B]]) <nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' For all patients, it may be reasonable to recommend [[omega-3]] fatty acids from fish or fish oil capsules (1 g/d) for cardiovascular disease risk reduction. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence:B'']]) <nowiki>"</nowiki> | ||
|} | |} | ||
Revision as of 15:20, 13 November 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Lipid Management
The goal is to successfully manage lipid levels, through statin therapy if necessary. Use statin therapy to achieve an LDL-C of <100 mg/dL; for very high risk patients an LDL-C <70 mg/dL is reasonable; if triglycerides are ≥200 mg/dL, non–HDL-C† should be <130 mg/dL, whereas non–HDL-C <100 mg/dL for very high risk patients is reasonable.
2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) [1]
Lipid Management (DO NOT EDIT) [1]
| Class I |
| "1. A lipid profile in all patients should be established, and for hospitalized patients, lipid-lowering therapy as recommended below should be initiated before discharge. [2] (Level of Evidence: B)" |
| "2. Lifestyle modifications including daily physical activity and weight management are strongly recommended for all patients. [3][4] (Level of Evidence: B)" |
| "3. Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), transfatty acids (to <1% of total calories), and cholesterol (to <200 mg/d). [5][6][7][8][4] (Level of Evidence: B)" |
| "4. In addition to therapeutic lifestyle changes, statin therapy should be prescribed in the absence of contraindications or documented adverse effects. [9][10][11][12][4] (Level of Evidence: A)" |
| "5. An adequate dose of statin should be used that reduces LDL-C to <100 mg/dL AND achieves at least a 30% lowering of LDL-C. [9][10][11][12][4] (Level of Evidence: C)" |
| "6. Patients who have triglycerides ≥200 mg/dL should be treated with statins to lower non–HDL-C to <130 mg/dL. [9][10][11][13] (Level of Evidence: B)" |
| "7. Patients who have triglycerides >500 mg/dL should be started on fibrate therapy in addition to statin therapy to prevent acute pancreatitis. (Level of Evidence: C)" |
| Class IIa |
| "1. If treatment with a statin (including trials of higher-dose statins and higher-potency statins) does not achieve the goal selected for a patient, intensification of LDL-C-lowering drug therapy with a bile acid sequestrant or niacin is reasonable. (Level of Evidence: B)" |
| "2. For patients who do not tolerate statins, LDL-C–lowering therapy with bile acid sequestrants and/or niacin is reasonable. (Level of Evidence: B)" |
| "3. It is reasonable to treat very high-risk patients with statin therapy to lower LDL-C to <70 mg/dL. (Level of Evidence: C)" |
| "4. In patients who are at very high risk and who have triglycerides ≥200 mg/dL, a non–HDL-C goal of <100 mg/dL is reasonable. (Level of Evidence: B)" |
| Class IIb |
| "1. The use of ezetimibe may be considered for patients who do not tolerate or achieve target LDL-C with statins, bile acid sequestrants, and/or niacin. (Level of Evidence:C) " |
| "2. For patients who continue to have an elevated non–HDL-C while on adequate statin therapy, niacin or fibrate therapy (Level of Evidence:B) or fish oil (Level of Evidence:C) may be reasonable. " |
| "3. For all patients, it may be reasonable to recommend omega-3 fatty acids from fish or fish oil capsules (1 g/d) for cardiovascular disease risk reduction. (Level of Evidence:B) " |
References
- ↑ 1.0 1.1 Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation". Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.
- ↑ Murphy SA, Cannon CP, Wiviott SD, McCabe CH, Braunwald E (2009). "Reduction in recurrent cardiovascular events with intensive lipid-lowering statin therapy compared with moderate lipid-lowering statin therapy after acute coronary syndromes from the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial". J. Am. Coll. Cardiol. 54 (25): 2358–62. doi:10.1016/j.jacc.2009.10.005. PMID 20082923. Unknown parameter
|month=ignored (help) - ↑ Dattilo AM, Kris-Etherton PM (1992). "Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis". Am. J. Clin. Nutr. 56 (2): 320–8. PMID 1386186. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 4.3 "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation. 106 (25): 3143–421. 2002. PMID 12485966. Unknown parameter
|month=ignored (help) - ↑ Ginsberg HN, Kris-Etherton P, Dennis B; et al. (1998). "Effects of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy subjects: the DELTA Study, protocol 1". Arterioscler. Thromb. Vasc. Biol. 18 (3): 441–9. PMID 9514413. Unknown parameter
|month=ignored (help) - ↑ Schaefer EJ, Lamon-Fava S, Ausman LM; et al. (1997). "Individual variability in lipoprotein cholesterol response to National Cholesterol Education Program Step 2 diets". Am. J. Clin. Nutr. 65 (3): 823–30. PMID 9062535. Unknown parameter
|month=ignored (help) - ↑ Schaefer EJ, Lichtenstein AH, Lamon-Fava S; et al. (1995). "Efficacy of a National Cholesterol Education Program Step 2 diet in normolipidemic and hypercholesterolemic middle-aged and elderly men and women". Arterioscler. Thromb. Vasc. Biol. 15 (8): 1079–85. PMID 7627699. Unknown parameter
|month=ignored (help) - ↑ Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM (1999). "Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis". Am. J. Clin. Nutr. 69 (4): 632–46. PMID 10197564. Unknown parameter
|month=ignored (help) - ↑ 9.0 9.1 9.2 "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial". Lancet. 360 (9326): 7–22. 2002. doi:10.1016/S0140-6736(02)09327-3. PMID 12114036. Unknown parameter
|month=ignored (help) - ↑ 10.0 10.1 10.2 LaRosa JC, Grundy SM, Waters DD; et al. (2005). "Intensive lipid lowering with atorvastatin in patients with stable coronary disease". N. Engl. J. Med. 352 (14): 1425–35. doi:10.1056/NEJMoa050461. PMID 15755765. Unknown parameter
|month=ignored (help) - ↑ 11.0 11.1 11.2 Pedersen TR, Faergeman O, Kastelein JJ; et al. (2005). "High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial". JAMA. 294 (19): 2437–45. doi:10.1001/jama.294.19.2437. PMID 16287954. Unknown parameter
|month=ignored (help) - ↑ 12.0 12.1 Baigent C, Blackwell L, Emberson J; et al. (2010). "Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials". Lancet. 376 (9753): 1670–81. doi:10.1016/S0140-6736(10)61350-5. PMC 2988224. PMID 21067804. Unknown parameter
|month=ignored (help) - ↑ Robinson JG, Wang S, Smith BJ, Jacobson TA (2009). "Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk". J. Am. Coll. Cardiol. 53 (4): 316–22. doi:10.1016/j.jacc.2008.10.024. PMID 19161879. Unknown parameter
|month=ignored (help)