Hey Gang ... I did a search and did not see this one. I am just wondering if the new Cholesterol guidelines are going to be on the Step 2ck ... Here some high points ... #1 and #2 IMO would be most likely tested. ... I would think all the NBME's have the old guidelines. Thoughts?
1. Discontinue those LDL standing orders
One of the most profound changes was the removal of the target LDL levels in patients with cardiovascular disease or its equivalents. These individuals are no longer treated to a goal of 100mg/dL, ideally 70mg/dL.
2. Four groups of patients should be treated with statins
Earlier, statin use was recommended only for those patients with a high 10-year cardiovascular risk of 20%. However, now there are many more patients who will be eligible for statin medication, representing perhaps the thorniest issue with the new guidelines. The four groups of patients who should be prescribed statins are:
- Clinical atherosclerotic cardiovascular disease
- LDL cholesterol greater than or equal to 190 mg/dL
- Diabetics aged 40 to 75 years
- LDL-cholesterol levels between 70 and 189mg/dL and a 10-year risk of atherosclerotic cardiovascular disease greater than or equal to 7.5%
3. If it’s not a statin, don’t prescribe it for hyperlipidemia
Others may affect the lab values, but statins (HMG-CoA reductase inhibitors) are the only lipid-lowering medications that have been shown to reduce cardiovascular events and mortality in both primary and secondary prevention trials. Non-statin therapies don’t offer any benefit. We could see this coming when ezetemide (Zetia) was found to be ineffective in lowering heart attack or stroke risk despite lowering LDL levels by 15 to 30 percent. Enthusiasm for non-statins was further dampened with the 2011 AIM-HIGH trial. This study of 3414 patients with stable coronary artery disease and low HDL levels was prematurely terminated when the adverse event rate (myocardial infarction, ischemic stroke, death from coronary artery disease, acute coronary syndrome hospitalization and revascularization) was 16.4% in the niacin group and 16.2% in the placebo group.
4. Out with Framingham, In with Pooled Cohort Risk Assessment
A town in Massachusetts, Framingham is best remembered for the famous study that led to the establishment of cardiac risk factors. The new guidelines replaces this risk calculator with the new Pooled Cohort Risk Assessment, which incorporates ethnicity and gender. The tool calculates risk of fatal and nonfatal stroke in addition to coronary heart disease. The patient’s calculated risk is important because it can determine if the patient receives a low-dose or a high-dose statin.
5. New dosing scale ... Too long to post
1. Discontinue those LDL standing orders
One of the most profound changes was the removal of the target LDL levels in patients with cardiovascular disease or its equivalents. These individuals are no longer treated to a goal of 100mg/dL, ideally 70mg/dL.
2. Four groups of patients should be treated with statins
Earlier, statin use was recommended only for those patients with a high 10-year cardiovascular risk of 20%. However, now there are many more patients who will be eligible for statin medication, representing perhaps the thorniest issue with the new guidelines. The four groups of patients who should be prescribed statins are:
- Clinical atherosclerotic cardiovascular disease
- LDL cholesterol greater than or equal to 190 mg/dL
- Diabetics aged 40 to 75 years
- LDL-cholesterol levels between 70 and 189mg/dL and a 10-year risk of atherosclerotic cardiovascular disease greater than or equal to 7.5%
3. If it’s not a statin, don’t prescribe it for hyperlipidemia
Others may affect the lab values, but statins (HMG-CoA reductase inhibitors) are the only lipid-lowering medications that have been shown to reduce cardiovascular events and mortality in both primary and secondary prevention trials. Non-statin therapies don’t offer any benefit. We could see this coming when ezetemide (Zetia) was found to be ineffective in lowering heart attack or stroke risk despite lowering LDL levels by 15 to 30 percent. Enthusiasm for non-statins was further dampened with the 2011 AIM-HIGH trial. This study of 3414 patients with stable coronary artery disease and low HDL levels was prematurely terminated when the adverse event rate (myocardial infarction, ischemic stroke, death from coronary artery disease, acute coronary syndrome hospitalization and revascularization) was 16.4% in the niacin group and 16.2% in the placebo group.
4. Out with Framingham, In with Pooled Cohort Risk Assessment
A town in Massachusetts, Framingham is best remembered for the famous study that led to the establishment of cardiac risk factors. The new guidelines replaces this risk calculator with the new Pooled Cohort Risk Assessment, which incorporates ethnicity and gender. The tool calculates risk of fatal and nonfatal stroke in addition to coronary heart disease. The patient’s calculated risk is important because it can determine if the patient receives a low-dose or a high-dose statin.
5. New dosing scale ... Too long to post
