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ATP III GUIDELINES

Management Of Dyslipidemias

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Risk Categories & TLC

Presented byDr. Md. Nazmul Ahsan

IMO. MU-1.SBMCH

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ATP III Lipid andLipoprotein Classification

190 Very high

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ATP III Lipid andLipoprotein Classification (continued)

60 High

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ATP III Lipid andLipoprotein Classification (continued)

240 High

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ATP III Lipid andLipoprotein Classification (continued)

Serum TriglyceridesNormal 500 mg/dL

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Major Risk Factors

Smoking

Hypertension Low HDL cholesterol Family history

Age

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Three Categories of Risk that ModifyLDL-Cholesterol Goals

CHD and CHD riskequivalentsMultiple (2+) riskfactorsZero to one riskfactors

)

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LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC)and Drug Therapy in Different Risk Categories

Risk Category LDL Goal(mg/dL)LDL Level at Which toInitiate TherapeuticLifestyle Changes

(TLC) (mg/dL )

LDL Level at Whichto ConsiderDrug Therapy(mg/dL)

CHD or CHD RiskEquivalents(10-year risk >20%)

130(100 129: drugOptional)

2+ Risk Factors(10-year risk

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Therapeutic LifestyleChanges (TLC)

TLC Diet

Reduced cholesterol-raising nutrients LDL-lowering therapeutic options Weight reduction

Increased physical activity

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Steps in TherapeuticLifestyle Changes (TLC)

Therapeutic Lifestyle Changes

Reduced saturated fats Moderate physical activity Referral - dietitian

Follow up - 6 weeks

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Steps in TherapeuticLifestyle Changes (TLC) (continued)

LDL response LDL-lowering therapy Follow up - 6 weeks

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Steps in TherapeuticLifestyle Changes (TLC) (continued)

LDL response Lifestyle therapy LDL-lowering drug Metabolic syndrome

Referral - dietitian

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Drug Therapy

Presented byDr. Md. Sorowar Hossain

IMO.MU-1.SBMCH

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Drug Therapy

Reduce LDL -C 18 55% & TG 7 30% Raise HDL -C 5 15%

Major side effects Myopathy Increased liver enzymes

Contraindications Absolute: liver disease Relative: use with certain drugs

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HMG CoA ReductaseInhibitors (Statins)

Lovastatin 20 80 mg

Pravastatin 20 40 mgSimvastatin 20 80 mgFluvastatin 20 80 mg

Atorvastatin 10 80 mgCerivastatin 0.4 0.8 mg

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HMG CoA ReductaseInhibitors (Statins) (continued)

Reduce major coronary events Reduce CHD mortality Reduce coronary procedures (PTCA/CABG) Reduce stroke

Reduce total mortality

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Bile Acid Sequestrants

Cholestyramine 4 16 gColestipol 5 20 gColesevelam 2.6 3.8 g

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Fibric Acids

Gemfibrozil 600 mg BID

Fenofibrate 200 mg QDClofibrate 1000 mg BID

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Secondary Prevention: Drug Therapyfor CHD and CHD Risk Equivalents

LDL-cholesterol goal:

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Secondary Prevention: Drug Therapyfor CHD and CHD Risk Equivalents (continued)

Patients Hospitalized for Coronary Eventsor Procedures

Measure LDL -C Discharge on drug Consider drug

Start lifestyle therapies

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Progression of Drug Therapyin Primary Prevention

InitiateLDL-loweringdrug therapy

If LDL goal notachieved,intensifyLDL-loweringtherapy

If LDL goal notachieved,intensify drugtherapy or referto a lipidspecialist

Monitorresponseandadherence totherapy

6 wks 6 wks4-6 mo

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