hyperlipdemia in a nut shell.ppt
- 1. Management of specific conditions • Treatment of elevated triglycerides: – when TGS > 500 then need to lower triglycerides first to prevent pancreatitis. – Otherwise need to reach LDL goal first, then non- HDL goal (LDL goal + 30 for VLDL). – Increase physical activity, intensify weight management first, then use fibrates or nicotinic acid to reduce VLDL and triglycerides.
- 2. The Management of Specific Conditions • Any three of the following: – 1. Abdominal Obesity • Waist circumference ( >40 in M, >35 in F) – 2. Triglycerides >150mg/dl – 3. HDL Cholesterol • <40 mg/dl in M, <50mg/dl in F – 4. Blood Pressure >130/>85 mmHg – 5. Fasting Glucose >110mg/dl 4. The Metabolic Syndrome:
- 3. Treatment of the Metabolic Syndrome: • Recognized as secondary target of risk reduction therapy after LDL cholesterol. – 1. Treat underlying causes • intensify weight management • increase physical activity – 2. Treat risk factors if they persist after lifestyle therapies. • Treat HTN, Use ASA for CHD, Treat increased triglycerides &/or Low HDL. The Management of Specific Conditions
- 4. Interventions to Improve Adherence • Simplify medication regimes. • Use good counseling techniques with patients. • Involve patients and their families in their care. • Increase visits / access to achieve goals. • Reinforce and reward compliance. • Multidisciplinary approach within the clinic. • Physician reminders to prompt attention to lipid management.
- 5. THE USE OF OMEGA-3 (EPA +DHA) IN HYPERTRIGLYCERIDEMIA, ESC 2019
- 6. Skulas-Ray AC et al. Circulation 2019 Aug 19 Prescription n-3 FAs (EPA+DHA or EPA- only) at a dose of 4 g/d (>3 g/d total EPA+DHA) are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents. All prescription agents appear comparably effective, but head-to-head comparisons are lacking AHA ScienceAdvisory
- 7. AHA Science Advisory 2019 Concerns have been raised that DHA-containing prescription agents may raise LDL-C in patients with HTG. We identified 9 trials of patients with HTG that reported effects on LDL-C with 4 g/d of DHA containing prescription n-3 FA (8 studies of O3AEE and 1 study of O3CA). In 8 of these 9 studies, there was no change in LDL-C versus placebo (4 of which used n-3 FA as an adjunct to statin therapy), whereas in 1 study, the median LDL-C was marginally increased by 3.5% versus placebo (P=0.052).31 This is similar to the change reported in REDUCE-IT, with a median increase in LDL-C of 3.1% from baseline (P<0.001) for EPA-only. Skulas-Ray AC et al. Circulation 2019 Aug 19
- 8. The use of Omega-3(EPA+DHA) in Hypertriglyceridemia, ESC2019
- 9. Take Home Messages • Focus on Multiple Risk Factors • New Lipid and Lipoprotein Classification • New recommendations for screening • More intensive tender loving care • New strategies for compliance
- 10. THANK YOU