Presentation on theme: "Lipid Management in 2015: Risk & Controversies"— Presentation transcript:
1Lipid Management in 2015: Risk & Controversies Michael Miller, MDR. Michael Benitez, MD
22013 ACC/AHA GuidelinesEmphasis on statins as first-line therapy due to strong body of supporting evidenceFocus on ‘appropriate intensity’ statin therapy in 3 groups ‘most likely to benefit’2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce AtheroscleroticCardiovascular Risk in Adults. Stone NJ, et al. Circulation 2013; JACC 2013
3#1 - Clinical Atherosclerotic CVD History of CAD, MI, stable/unstable anginaCoronary or other arterial revascularizationCVA / TIAPeripheral arterial disease
710 Year ASCVD Risk: Pooled Cohort Equation DemographicsAge (40-79)GenderRaceHistoryHTNDMTobaccoMeasurementsTcholHDLSystolic BP
8Estimated 10 year risk >7.5% The guidelines state that the risk estimator does not, and should not determine which patients receive statinsStatin use should be determined after a ‘detailed risk discussion’ between patient and physician
9Case 1 Tom is a 55 year old African American man He had a NSTEMI at age 50, with subsequent PCI of the LAD.He is on atorvastatin 80 mg/daily, along with aspirin, beta-blocker and ACE-i.
12Questions Should we still follow levels? How often should we follow levels?The current guidelines are very focused on statin therapy . . .What is the role of non-statin therapy for elevated LDL cholesterol?
13Case 2 Tom’s older brother, aged 60, comes to see you. He had CABG at age 52, is a never- smoker, but has hypertension and type II diabetes, with a hemoglobin A1c of 7%.He shops with Tom, and they are both on Atorvastatin 80 mg daily. He is on no other lipid lowering medicine.
15Questions?Should he be treated with another agent for his elevated triglycerides?Should he receive any treatment targeted towards the low HDL cholesterol?
16Case 3 Tom’s younger brother, age 50, also comes to see you. He is asymptomatic and has no known history of CAD, but he is worried that both of this older brothers had serious heart disease at about his age.He is a ‘never-smoker’, and is not hypertensive or diabetic.Tchol 220 / HDL 44 / SBP 132 mm Hg