Lipid Management for primary prevention of

ASCVDStan Schwartz, MD

Well, OK

Relevant Disclosure and ResolutionUnder Accreditation Council for Continuing Medical Education

guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months.

Stan Schwartz, MD

I have no relevant financial relationships or affiliations with commercial interests to disclose.

Experimental or Off-Label Drug/Therapy/Device Disclosure

I will NOT be discussing experimental or off-label drugs, therapies and/or devices that have not been approved by the FDA.

Learning Objectives

Upon completion of this session, participants will improve their competence and performance by being able to:

1. Identify the differences between the USPSTF guidelines and the Academic Detailing Aid

2. Change the detailing approach to helping practices understand the USPSTF guidelines.

Lipid guidelines one generation ago

Decide whether primary or secondary prevention• ASCVD

• History of myocardial infarction• Acute coronary syndromes• Stable or unstable angina• Coronary or other arterial revascularization• Stroke• TIA• Peripheral arterial disease

Presumed to be of atherosclerotic origin

Intensity of treatment

Determine risk

55 year old manSBP 138SmokerWhiteChol-HDL 40 mg/dlChol-Total 250TG 180(LDL-calculated) 174

https://statindecisionaid.mayoclinic.org/

United States Prev Services Task Force 2016

10 year risk 10% or greater

Low to moderate dose statinGrade B

10 year risk 7.5 - 10%

Low to moderate dose statinGrade C

● Age 40-74 (75+ = Grade I)● No ASCVD● 1or more risk factors

○ HTN, dyslipidemia, diabetes, smoking(dyslipidemia = LDL-C > 130 mg/dl or HDL < 40 mg/dl)

10% risk is a lot of people

Age 60-69:

40% of men without ASCVD27% of women without ASCVDWill have 10 year risk of 10% or greater

USPSTF vs our guidelines: treat or not treat?

72 year old manno smokingHDL-C 55Total-C 180SBP 118No diabetes10 yr risk = 15%

Other clinical factors?

• Family history of premature ASCVD • < 55 years in 1st degree male relative or < 65 years in 1st degree female

relative) • High-sensitivity C-reactive protein ≥ 2 mg/L • Coronary artery calcium score ≥ 300 Agatston units 7 • Ankle brachial index < 0.9 • Elevated lifetime risk of ASCVD

References