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
Medications:
- 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
- Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)
- Patients with primary LDL-C levels of 190 mg per dL or greater
- Patients with diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
- 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
Treatment
- 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
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