Guidelines for Treatment of Hyperlipidia and CAD
Coronary heart disease (CAD) is one of the leading causes of morbidity and mortality for both women and men in the US and worldwide. CAD prevention is based on removing or reducing modifiable risk factors that contribute to its development (Jellinger et al 2017). Hyperlipidemia is one of these modifiable risk factors.
The guidelines for the treatment of hyperlipidemia and CAD are published by various agencies. However, the latest guidelines have been developed by the American Association of Clinical Endocrinologists (AACE). The 2017 AACE guidelines provide 87 recommendations on array of clinical scenarios faced in clinical practice. These guidelines adhere to published protocols and standards for the generation of clinical practice guidelines (CPGs). The CPG is a tool that healthcare providers can employ to diagnose and treat hyperlipidemia and prevent CAD.
The CPG recommends the use of LDL particle concentration or apolipoprotein B level to refine efforts to attain successful LDL-C lowering (Jellinger et al 2017). It also provides screening recommendations for persons of varied ages. In addition to emphasizing the significance of LDL-C lowering, CPG supports the measurement of inflammatory markers in order to stratify risks in certain health situations. CPG also prevents a detailed evaluation of cost-effectiveness lipid lowering management. Last but not least, CPG guideline gives special consideration to children and women with hyperlipidemia and those with diabetes.
The AACE guidelines recommend specific LDL-C targets for particular risk factors. Targeting specific levels of LDL-C has been accorded the strongest recommendation by the level I evidence (Lloyd-Jones et al. 2016). Statins are recommended for the treatment of elevated LDL-C levels (Carreras, & Polk, 2017). Statin works by inhibiting hydroxymethylglutaryl CoA reductase, resulting in a decrease in cholesterol and improved intake of hepatic LDL, thereby reducing serum LDL. High intensity statin has been found to further lower LDL-C, and is associated with an improvement in the relative risk reduction of coronary heart disease.
Carreras, E. & Polk, D. (2017). Dyslipidemia: Current Therapies and Guidelines for Treatment. US Cardiology Review, 11(1):10–5
Jellinger, P. S. et al. (2017). AACE 2017 Guidelines: American Association Of Clinical Endocrinologists And American College Of Endocrinology Guidelines for management of dyslipidemia and prevention of cardiovascular disease. CPG for Managing Dyslidemia and Prevention of CVD, EndocrPract, 23(Suppl 2)3-6
Lloyd-Jones D. M, et al. (2016). 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiology, 68:92-125.
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