Recommendations for management of dyslipidemia in high cardiovascular risk patients

Abstract

Overwhelming evidence supports a causal relationship between elevated levels of plasma cholesterol, particularly low-density lipoprotein cholesterol, and increased risk of coronary artery disease, which remains the leading cause of death and morbidity worldwide. Low-density lipoprotein cholesterol lowering has been the main goal of therapy, and clinical trial results from recently published studies of intensive statin therapy confirm the benefits of more aggressive lipid-lowering targets, particularly in subjects at high risk for cardiovascular events. This management update will focus on the implications of risk reduction in patients at high cardiovascular risk, and will provide practical steps to help further risk stratify these patients and help them reach their target goals.

Keywords: Coronary artery disease; Dyslipidemia; LDL cholesterol; Treatment.

Figure 1

Proposed algorithm for Canadian Cardiovascular Society high-risk patients. ABI Ankle-brachial index; ACS Acute coronary syndrome; CABG Coronary artery bypass graft; CAD Coronary artery disease; CTA Computed tomography angiogram; CVD Cardiovascular disease; DM Diabetes mellitus; ECG Electrocardiogram; IMT Intima-media thickness; LDL-C Low-density lipoprotein cholesterol; PCI Percutaneous coronary intervention; PVD Peripheral vascular disease; TC/HDL-C Total cholesterol to high-density lipoprotein cholesterol ratio; SBP Systolic blood pressure; TIA Transient ischemic attack

Figure 2

Therapy approach in high-risk patients. *Preferred intervention. ↓ Decrase; ↓ Increase; LDL-C Low-density lipoprotein cholesterol; TC/HDL-C Total cholesterol to high-denisty lipoprotein cholesterol ratio