May 14, 2014 — The National Lipid Assn. (NLA) released a draft summary that highlights key aspects of care that provide a thorough supplement and direction for clinicians treating patients with dyslipidemia.
The document was created by an expert panel comprised of NLA members who are leaders in the field of clinical lipidology. The panel’s goal was to harmonize guidelines among what has been presented in the past by the ATP panel, the American Heart Assn./American College of Cardiology and those also released in the international community.
“We wanted to make sure that any clinician following guidelines realizes that they are just that: guidelines to be used in a broad sense of the word,” said Matthew K. Ito, doctor of pharmacy and president of the NLA. “But we realize that individual patients bring a set of problems that are relatively uncommon when considered as a package. Considering only risk factors that are suitable to community-based analysis does not get the job done. Generalizations based on such data can often lead to an unsatisfactory approach to the individual patient.”
As such, the NLA recommendations make it clear that clinicians should assess patient risk and be able then to identify a treatment regime that gets the patient to well established goals.
“As lipidologists, the NLA wants to assist all clinicians to best manage their patients within the context of 'real world' medicine,” said Ito. “We believe these recommendations do that; they are both clinically practical and scientifically based.”
While the NLA encourages adoption and use of these recommendations, it recognizes that clinical judgment and evolving evidence constantly need to be incorporated to fortify clinician approaches to patient care.
Highlights of the recommendations for patient-centered treatment of dyslipidemia include:
Risk identification is the first crucial step to arrive at appropriate decisions by the health care provider and the patient to initiate healthy lifestyle changes and, potentially, drug therapy. The highest risk patients for future cardiovascular disease (CVD) events will always be those with established atherosclerotic cardiovascular disease (ASCVD).
In primary prevention situations, the presence of three or more major risk factors, familial hypercholesterolemia (FH) and simultaneously occurring high-risk disease states (such as diabetes and chronic kidney disease) are to be considered high-risk status.
Risk calculators can be confusing for many clinicians but can be beneficial when addressing patients that fall in the moderate risk group. The Framingham Risk Score 10-year hard coronary heart disease (CHD) endpoints is the preferred one for clinical decisions. Lifetime risk can also be used for patients under 50 years old.
Measures and Goals
Non-HDL-C and LDL-C are the clinical measures of atherogenic lipoprotein contribution to ASCVD risk, and these parameters should be obtained in the baseline assessment and as targets of treatment.
Clinicians should always steer therapy toward meeting goals, including lifestyle choices like diet and exercise, and include therapeutics when necessary to achieve the stated goals.
The NLA is seeking input and comments from NLA members, stakeholder organizations and other related medical societies as well any other individual or group who cares for patients with dyslipidemias and other related disorders.
Comments on this document can be made until May 31, 2014 at www.lipid.org/publiccomments.
After the NLA has received comments from all entities, the expert panel will reconvene and consider every comment submitted regarding these recommendations. The expert panel will then review and adjudicates the comments, publishing a final paper in the September/October issue of the Journal of Clinical Lipidology.
For more information: www.lipid.org