Practice Guidelines

Dyslipidemia Management for Cardiovascular Disease Prevention: Guidelines from the VA/DoD

 

Key Points for Practice

• In primary prevention, moderate-dose statins are recommended when treatment is indicated.

• In secondary prevention, moderate-dose statins are recommended with intensification by increasing statin dose, adding ezetimibe, or adding a PCSK9 inhibitor in higher-risk patients.

• Because cholesterol values are stable over 10 years, new measurements are not needed for each risk assessment.

From the AFP Editors

Cardiovascular disease caused by atherosclerosis causes significant morbidity and mortality, which can be improved by controlling risk factors through lifestyle interventions and lipid-lowering medications. The U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) have updated recommendations for evaluation and management of dyslipidemia to prevent cardiovascular disease (Figure 1).

FIGURE 1.

Algorithm for the management of dyslipidemia for cardiovascular risk reduction.

Adapted from U.S. Department of Veterans Affairs. VA/DoD clinical practice guideline for the management of dyslipidemia for cardiovascular risk reduction. Accessed September 24, 2020. https://www.healthquality.va.gov/guidelines/CD/lipids/


FIGURE 1.

Algorithm for the management of dyslipidemia for cardiovascular risk reduction.

Adapted from U.S. Department of Veterans Affairs. VA/DoD clinical practice guideline for the management of dyslipidemia for cardiovascular risk reduction. Accessed September 24, 2020. https://www.healthquality.va.gov/guidelines/CD/lipids/

Primary Prevention

Without known cardiovascular disease, treatment decisions should be based on estimated 10-year risk calculators such as the pooled cohort equations (http://tools.acc.org/ASCVD-Risk-Estimator-Plus). Treatment is recommended at a 10-year risk of 12%, which matches the populations that experienced benefit in clinical trials. People with diabetes mellitus and/or low-density lipoprotein cholesterol levels of at least 190 mg per dL (4.92 mmol per L) are also at high risk and should be offered treatment regardless of estimated risk. Shared decision-making is recommended with 10-year risk between 6% and 12%, which represents populations less studied in clinical trials.

Moderate-dose statins are the sole medication recommended for primary prevention. The group recommends against high-dose statins, citing

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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