From the Guidelines
Dyslipidemia management should prioritize lowering LDL cholesterol to less than 55 mg/dL and reducing it by at least 50% if the baseline LDL-C level is 70-135 mg/dL, with statin treatment being the first-line approach, as recommended by the most recent guidelines 1. The primary goal of dyslipidemia management is to reduce cardiovascular risk through lipid management.
Key Recommendations
- Statins are the first-line medication for dyslipidemia, with common options including atorvastatin, rosuvastatin, and simvastatin, and treatment should start with a moderate-intensity statin and be titrated up if needed 1.
- For patients who don't achieve target LDL levels with statins alone, ezetimibe can be added, as demonstrated to decrease cholesterol and cardiovascular events in post-ACS patients and in patients with diabetes 1.
- Lifestyle modifications are crucial and should be recommended to all patients, including:
- Adopting a heart-healthy diet low in saturated fats and rich in fruits, vegetables, and whole grains
- Regular physical activity (at least 150 minutes of moderate-intensity exercise per week)
- Weight management to achieve and maintain a healthy BMI
- Smoking cessation
- Limiting alcohol consumption
Individualized Treatment
Treatment should be individualized based on the patient's overall cardiovascular risk, which takes into account factors such as age, gender, blood pressure, diabetes status, and smoking history, as emphasized in previous guidelines 1.
Regular Monitoring
Regular monitoring of lipid levels and adjustment of therapy as needed is essential for optimal management of dyslipidemia, with lipid levels being measured at least annually and more often if needed to achieve goals 1.
From the FDA Drug Label
To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD As an adjunct to diet to reduce low-density lipoprotein (LDL-C) in: Adults with primary hyperlipidemia Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia. As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia. Hypertriglyceridemia.
The guidelines for managing Dyslipidemia include:
- Reducing the risk of myocardial infarction, stroke, and angina in adults with multiple risk factors for coronary heart disease
- Using statins (such as atorvastatin or rosuvastatin) as an adjunct to diet to reduce LDL-C in adults with primary hyperlipidemia, heterozygous familial hypercholesterolemia, and homozygous familial hypercholesterolemia
- Using statins as an adjunct to diet for the treatment of adults with primary dysbetalipoproteinemia and hypertriglyceridemia 2 3
From the Research
Guidelines for Managing Dyslipidemia
The management of dyslipidemia involves a combination of lifestyle therapy and pharmacologic treatment. The following are some guidelines for managing dyslipidemia:
- Lifestyle therapy is the first line of treatment and includes improving nutrition, physical activity, weight, and other factors that affect lipids 4, 5, 6, 7, 8
- Secondary causes of lipid disorders should be addressed, and pharmacologic therapy initiated based on a patient's risk for atherosclerotic cardiovascular disease (ASCVD) 4
- Patients at extreme ASCVD risk should be treated with high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol (LDL-C) of <55 mg/dL, and those at very high ASCVD risk should be treated to achieve LDL-C <70 mg/dL 4
- Treatment for moderate and high ASCVD risk patients may begin with a moderate-intensity statin to achieve an LDL-C <100 mg/dL, while the LDL-C goal is <130 mg/dL for those at low risk 4
- When targeting triglyceride levels, the desirable goal is <150 mg/dL 4
- Statin therapy should be combined with a fibrate, prescription-grade omega-3 fatty acid, and/or niacin to reduce triglycerides in all patients with triglycerides ≥500 mg/dL 4
Dietary Management
Dietary management is an essential component of treating dyslipidemia. The following are some dietary recommendations:
- A healthy dietary pattern is a cornerstone for treating elevated low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG) 5
- Constituent food and nutrient intakes impact LDL-C and TG lowering 5
- Food- and nutrient-based recommendations for lowering both LDL-C and TG should be individualized and customized to patient preferences 5
- Popular diets such as the NCEP step I and step II diets may be effective in improving blood lipids and other risk factors 8
Pharmacologic Treatment
Pharmacologic treatment is often necessary to achieve optimal lipid levels. The following are some pharmacologic treatment options:
- Statins are the primary pharmacologic treatment for dyslipidemia and can decrease low-density lipoprotein (LDL) cholesterol levels by up to 55% 4, 6
- Other LDL-C-lowering agents such as proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, colesevelam, or bempedoic acid may be added to statin therapy as needed to achieve treatment goals 4
- Fibrates, prescription-grade omega-3 fatty acid, and/or niacin may be used to reduce triglycerides in patients with high triglyceride levels 4, 6