PANCE Blueprint Cardiology (13%)

Lipid disorders (PEARLS)

The NCCPA™ PANCE Cardiology System Content Blueprint includes two topics related to lipid disorders

Hypercholesterolemia Subcutaneous xanthomas, premature arcus senilis, lipemia retinalis


  • Statins: Side effects: Elevated LFTs, myalgias
  • Fibrates: Side effects: Gallstones
  • Niacin: Side effects: Flushing
  • Bile acid sequestrants (Cholestyramine): Side effects: Diarrhea

Statin Therapy:

Key Points for Practice (based on the latest treatment guidelines) 

The guideline emphasizes that lifestyle modification remains a critical component of atherosclerotic cardiovascular disease (ASCVD) reduction

Four groups most likely to benefit from statin therapy
  1. Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)
  2. Patients with primary LDL-C levels of 190 mg per dL or greater
  3. Patients with diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
  4. Patients without diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%

Risk assessment for 10-year and lifetime risk is recommended using an updated ASCVD risk calculator

Hypertriglyceridemia Obtain fasting lipid panel beginning at age 20 and repeated every 5 years

  • Normal <150 mg/dL
  • Mild hypertriglyceridemia  150 to 499 mg/dL
  • Moderate hypertriglyceridemia 500 to 886 mg/dL
  • Very high or severe hypertriglyceridemia 886 mg/dL


  • Triglyceride level should be reduced to < 500 mg/dL to prevent this pancreatitis
  • Isolated triglycerides are treated with Fibrates (gemfibrozil and fenofibrate) and Niacin
  • Niacin may cause hyperglycemia so caution in patients with DM
  • Flushing treated with daily aspirin, will have a beneficial effect on HDL cholesterol


Vasovagal hypotension (Prev Lesson)
(Next Lesson) Hypercholesterolemia
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