Management and Treatment of Lipidemia
With elevated levels of LDL-C, evidence has shown that lowering it results in a reduction of cardiovascular disease (CVD) events. Among these events, myocardial infarction (MI) was reduced the most, making treatment mandatory.
Treatment is based on the risk of suffering a CV event within 10 years, predicted by an assessment of the lipid panel and consideration of other risk factors.
When the normal balance of production and clearance is upset and cholesterol increases abnormally in the blood to pose a risk of CVD, statins are used to bring levels back into a normal balance. Statins lower cholesterol by reducing the production of cholesterol by the liver.
For starter therapy, one of the moderate-intensity statins is begun:
- Lovostatin (Mevacor, Altoprev), 40 mg.
- Pravastatin (Pravachol), 40 mg.
- Simvastatin (Zocor), 40 mg.
- Atorvastatin (Lipitor), 10 to 20 mg.
- Rosuvastatin (Crestor), 5 to 10 mg
When moderate intensity statins fail, high-intensity statin therapy is used:
- Atorvastatin (Lipitor), 40 to 80 mg
- Rosuvastatin (Crestor), 20 to 40 mg
Decision to Treat
Current guidelines recommend that any adults aged 40-75 without CVD but with an LDL-C between 70-189 mg/dL should be treated: treatment with moderate-intensity statin therapy is recommend for those with an estimated 10-year CVD risk between 5.0-7.5%; those with an estimated 10-year CVD risk ≥7.5% are treated with moderate-to-high intensity statin therapy.
For patients at high risk, which is the group to which diabetics belong, the LDL-C should be lowered to <100 mg/dL, or at least 50% of their baseline levels.
For very high-risk patients, LDL-C should be lowered to <70 mg/dL, or a reduction of at least 50 percent of their baseline levels.
Measuring LDL-C response to statins at the 6-week mark, followed by lipid panels yearly, is the protocol used to assess appropriate lowering of LDL-C from a treatment regimen.