ITEMS IN AFP WITH KEYWORD:
In June 2020, the third iteration of the U.S. Department of Veterans Affairs and Department of Defense guidelines on managing dyslipidemia was published. These recommendations create a simple, pragmatic, evidence-based approach that can be valuable to family physicians.
The U.S. Department of Veterans Affairs and Department of Defense have updated recommendations for evaluation and management of dyslipidemia to prevent cardiovascular disease.
Bempedoic acid is labeled as add-on therapy to diet and maximally tolerated statin for the treatment of familial hypercholesterolemia or atherosclerotic cardiovascular disease.
Icosapent ethyl is safe, well tolerated and effective in preventing ischemic events including stroke and heart attack.
Hypertriglyceridemia is associated with increased risk of cardiovascular disease, and severely elevated triglyceride levels increase the risk of pancreatitis. Common risk factors for hypertriglyceridemia include obesity, metabolic syndrome, and type 2 diabetes mellitus. Management starts with lifestyle modifications such as diet and exercise. Statins can be considered for patients with high triglyceride levels who have borderline or intermediate 10-year risk of atherosclerotic cardiovascular disease. Icosapent can be added in patients at high cardiovascular risk if triglyceride levels remain high despite statin use. Fibrates, omega-3 fatty acids, or niacin may be considered in patients with severe hypertriglyceridemia to reduce the risk of pancreatitis.
These updated guidelines, made without any input from primary care physicians who manage most patients with hyperlipidemia, are more complex than the 2013 guidelines and will likely lead to even more recommendations for statins, ezetimibe (Zetia), and PSK9 inhibitors.
The American College of Cardiology/American Heart Association (ACC/AHA) task force on clinical practice guidelines has updated its 2013 cholesterol guideline.
These results confirm that the use of statins for men with an LDL cholesterol level of at least 190 mg per dL, regardless of calculated risk, is associated with a clinically and statistically significant reduction in cardiovascular events and probably cardiovascular and all-cause mortality.
Prescription niacin (nicotinic acid, vitamin B3) does not reduce myocardial infarctions, strokes, or overall mortality when used for primary or secondary prevention.
Dec 15, 2017 Issue
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults [Putting Prevention into Practice]
L.D., a 66-year-old generally healthy white man, presents for his annual physical. He has no history of cardiovascular disease (CVD); he has had consistent systolic blood pressure measurements of 140 mm Hg; he is not taking any medications; he does not smoke; he exercises three times per week; and his body mass index is 25 kg per m2.