Feature | May 14, 2014

National Lipid Assn. Releases Draft Recommendations for Patient-Centered Treatment of Dyslipidemia

Health care providers invited to review and comment on recommendations before final publication

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:

Assessing Risk

  • 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

Related Content

bivalirudin, heparin, blood clot prevention medication, PCI, percutaneous coronary intervention, Intermountain study, AHA Scientific Sessions
News | Antiplatelet and Anticoagulation Therapies| November 14, 2016
Two differing blood clot prevention medications are just as safe and effective for patients undergoing percutaneous...
Aggrastat Bolus Vial, IV antiplatelet agent
Technology | Antiplatelet and Anticoagulation Therapies| October 28, 2016
October 28, 2016 — Medicure Inc. recently received U.S.
Mercator MedSystems, Bullfrog Micro-Infusion Device, DANCE trial, VIVA 2016, 13-month results
News | Peripheral Arterial Disease (PAD)| October 07, 2016
Mercator MedSystems recently announced that 13-month data from the DANCE trial was presented during a late-breaking...
News | Pharmaceuticals| September 26, 2016
Nearly 2 out of 5 people with diabetes who could benefit from statin therapy to lower their risk of future heart attack...
TAILOR-PCI study, antiplatelet medication, genotype, NHLBI grant
News | Antiplatelet and Anticoagulation Therapies| August 18, 2016
Researchers at the Peter Munk Cardiac Centre, Toronto, and at Mayo Clinic are leading the Tailored Antiplatelet Therapy...
pros and cons of new anticoagulation therapies, anticoagulants, dabigatran, Pradaxa, novel oral anticoagulants, NOACs, rivaroxaban, Xarelto, apixaban, Eliquis
Feature | Antiplatelet and Anticoagulation Therapies| July 26, 2016 | Heidi Olson, Pharm.D
With the recent introduction of several novel oral...
beta-blockers, Thomas Jefferson University, beta-adrenergic receptors

Selective activation of the beta2-adrenergic receptor (beta2AR) by a beta-arrestin-biased pepducin promotes activation of a beta-arrestin signaling pathway that is cardioprotective. Image courtesy of the lab of Jeffrey Benovic, Thomas Jefferson University.

News | Heart Failure| June 30, 2016
Researchers at Thomas Jefferson University have discovered how to enhance the effectiveness of beta-blockers for heart...
atrial fibrillation, stroke risk, aspirin vs blood thinners, JACC study
News | Antiplatelet and Anticoagulation Therapies| June 24, 2016
More than 1 in 3 atrial fibrillation (AF) patients at intermediate to high risk for stroke are treated with aspirin...
anticoagulants, U.S. market, Technavio, 2020, trends
News | Antiplatelet and Anticoagulation Therapies| May 25, 2016
Technavio’s latest report on the U.S. anticoagulants market provides an analysis on the most important trends expected...
clot, coronary thrombus, antiplatelet therapt, DAPT

An intravascular ultrasound (IVUS) image of a thrombus formed in a coronary artery.  While there are guidelines for antiplatelet therapy, there are still questions over the duration of such therapy. 

Feature | Antiplatelet and Anticoagulation Therapies| May 19, 2016 | Marianne Pop, Pharm.D., BCPS
 
Overlay Init