What is the diagnosis and treatment for Dyslipidemia?

From the Guidelines

Dyslipidemia should be treated with statins as the first-line pharmacological treatment, with the goal of lowering LDL cholesterol to target levels, as this approach has been shown to reduce the risk of cardiovascular disease and improve quality of life 1. The diagnosis of dyslipidemia involves assessing lipid levels, including LDL cholesterol, HDL cholesterol, and triglycerides. Treatment typically begins with lifestyle modifications, such as:

• Adopting a heart-healthy diet low in saturated fats and trans fats
• Regular physical activity, aiming for 150 minutes of moderate exercise weekly
• Weight management
• Smoking cessation
• Limiting alcohol consumption If lifestyle changes are insufficient, medication therapy is often necessary.
• Statins, including atorvastatin (10-80 mg daily), rosuvastatin (5-40 mg daily), or simvastatin (10-40 mg daily), are recommended as the first-choice lipid-lowering treatment in patients with high LDL-C levels 1.
• If the target LDL-C is not reached, combination therapy with ezetimibe is recommended 1.
• In patients at very high CV risk, with persistent high LDL-C despite treatment with maximal tolerated statin dose, in combination with ezetimibe, or in patients with statin intolerance, a PCSK9 inhibitor is recommended 1. Regular monitoring of lipid levels every 3-12 months is essential to assess treatment efficacy. Dyslipidemia requires attention because it significantly increases the risk of cardiovascular disease, as abnormal lipid particles can accumulate in arterial walls, forming plaques that restrict blood flow and potentially lead to heart attacks or strokes. Key considerations in treatment include:
• The CV risk profile of the patient
• The recommended LDL-C (or non-HDL-C) target levels
• The potential for statin intolerance or contraindications, such as in women of childbearing potential 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnosis of Dyslipidemia

• The diagnosis of dyslipidemia is the initial step in lipid management, and it is based on the estimation of the 10-year risk of atherosclerotic disease 2
• A validated clinical scoring tool can be used to estimate the 10-year risk of atherosclerotic disease, and patients are classified into low, intermediate, and high-risk categories 2
• Patients with diabetes mellitus, chronic kidney disease, or peripheral arterial disease are considered at high risk without calculating the risk score 2

Treatment of Dyslipidemia

• Lifestyle therapy is the first line of treatment for dyslipidemia, and it includes improving nutrition, physical activity, weight, and other factors that affect lipids 3
• Pharmacologic therapy is initiated based on a patient's risk for atherosclerotic cardiovascular disease (ASCVD), and high-intensity statin therapy is recommended for patients at extreme ASCVD risk 3
• The treatment goals for low-density lipoprotein cholesterol (LDL-C) are <55 mg/dL for patients at extreme ASCVD risk, <70 mg/dL for patients at very high ASCVD risk, <100 mg/dL for patients at moderate and high ASCVD risk, and <130 mg/dL for patients at low risk 3
• Other LDL-C-lowering agents, such as proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, colesevelam, or bempedoic acid, can be added to statin therapy as needed to achieve treatment goals 3
• For patients with triglycerides ≥500 mg/dL, statin therapy should be combined with a fibrate, prescription-grade omega-3 fatty acid, and/or niacin to reduce triglycerides 3
• Dietary management is also an important aspect of treating dyslipidemia, and a healthy dietary pattern can help lower LDL-C and triglycerides 4
• Exercise and dietary interventions can be effective in improving blood lipids, other risk factors, and quality of life 5

Secondary Prevention

• Secondary prevention of acute coronary syndrome, diabetes mellitus, and atherosclerotic brain infarction is associated with the highest risk of cardiovascular disease, and high-intensity statin therapy is recommended as the first-line treatment in this group 2
• The addition of ezetimibe is recommended first if LDL-C levels remain elevated with maximal statins, and the addition of a Proprotein Convertase Subtilisin/Kexin type 9 inhibitor to strong statins is recommended for patients with coronary artery disease whose LDL-C levels remain elevated despite the administration of maximal LDL-C-lowering therapy 2
• Statin therapy has been shown to reduce the relative risk of cardiovascular disease by 24-37%, regardless of age, sex, prior history of coronary heart disease, or other co-morbid conditions 6