What are the patient's lipid levels?

From the Guidelines

The patient's lipid levels should be measured at least annually, with a goal of LDL-C level 100 mg/dL, HDL-C above 50 mg/dL, and triglycerides below 150 mg/dL, as recommended by the American Heart Association and the American Diabetes Association 1. To achieve these lipid levels, lifestyle modification is essential, including reduction of saturated fat and cholesterol intake, weight loss if indicated, and increases in dietary fiber and physical activity 1. Some key points to consider when managing lipid levels include:

• In adults under the age of 40 years with low-risk lipid values, lipid assessments may be repeated every 2 years 1.
• For individuals with diabetes who are over the age of 40 years, without overt CVD, but with 1 or more major CVD risk factors, the primary goal is an LDL-C level 100 mg/dL, and statin therapy should be initiated on the basis of risk factor assessment and clinical judgment 1.
• In individuals with diabetes who are under the age of 40 years, without overt CVD, but who are estimated to be at increased risk of CVD, the LDL-C goal is 100 mg/dL, and LDL-lowering drugs should be considered if lifestyle changes do not achieve the goal 1. It is also important to note that the American Heart Association suggests a non–HDL-C goal of 130 mg/dL as a secondary target for patients with triglyceride levels of 200 to 499 mg/dL 1. Overall, managing lipid levels is crucial for reducing the risk of cardiovascular events, and a combination of lifestyle modifications and medications can help achieve optimal lipid levels 1.

From the FDA Drug Label

In the overall population, the mean LDL-C reduction from baseline was 22%. Mean LDL-C at baseline was 416 mg/dL (range 152 mg/dL to 716 mg/dL). Table 14: Lipid-modifying Effects of Rosuvastatin in Pediatric Patients 7 to 15 years of Age with HoFH After 6 Weeks LDL-C (mg/dL) 481 396 -22.3% (-33.5, -9.1) Table 15: Lipid-modifying Effects of Rosuvastatin 10 mg and 20 mg in Adult Patients with Primary Dysbetalipoproteinemia (Type III hyperlipoproteinemia) After Six Weeks by Median Percent Change (95% CI) from Baseline (N=32) Median at Baseline (mg/dL) Median percent change from baseline (95% CI) Rosuvastatin 10 mg Median percent change from baseline (95% CI) Rosuvastatin 20 mg Total-C 342.5 -43.3 (-46.9, -37.5) -47.6 (-51.6, -42.8) Triglycerides 503.5 -40.1 (-44.9, -33.6) -43.0 (-52.5, -33.1) Non-HDL-C 294.5 -48.2 (-56.7, -45.6) -56.4 (-61.4, -48.5) VLDL-C + IDL-C 209.5 -46.8 (-53.7, -39.4) -56.2 (-67.7, -43.7) LDL-C 112.5 -54.4 (-59.1, -47.3) -57.3 (-59.4, -52.1) HDL-C 35.5 10.2 (1.9,12.3) 11.2 (8.3,20.5) Table 16: Lipid-Modifying Effect of Rosuvastatin in Adult Patients with Primary Hypertriglyceridemia After Six Weeks by Median (Min, Max) Percent Change from Baseline to Week 6 Triglycerides 1 (-40,72) -21 (-58,38) -37 (-65,5) -37 (-72,11) -43 (-80, -7) Non-HDL-C 2 (-13,19) -29 (-43, -8) -49 (-59, -20) -43 (-74,12) -51 (-62, -6) Total-C 1 (-13,17) -24 (-40, -4) -40 (-51, -14) -34 (-61, -11) -40 (-51, -4) LDL-C 5 (-30,52) -28 (-71,2) -45 (-59,7) -31 (-66,34) -43 (-61, -3) HDL-C -3 (-25,18) 3 (-38,33) 8 (-8,24) 22 (-5,50) 17 (-14,63)

The patient's lipid levels are as follows:

• LDL-C (Low-Density Lipoprotein Cholesterol):
  • Mean baseline: 416 mg/dL (range 152 mg/dL to 716 mg/dL) in pediatric patients with HoFH
  • Mean baseline: 112.5 mg/dL in adult patients with primary dysbetalipoproteinemia
  • Mean baseline: 5 mg/dL (range -30 to 52) in adult patients with primary hypertriglyceridemia
• Total-C (Total Cholesterol):
  • Mean baseline: 342.5 mg/dL in adult patients with primary dysbetalipoproteinemia
  • Mean baseline: 1 mg/dL (range -13 to 17) in adult patients with primary hypertriglyceridemia
• Non-HDL-C (Non-High-Density Lipoprotein Cholesterol):
  • Mean baseline: 294.5 mg/dL in adult patients with primary dysbetalipoproteinemia
  • Mean baseline: 2 mg/dL (range -13 to 19) in adult patients with primary hypertriglyceridemia
• Triglycerides:
  • Mean baseline: 503.5 mg/dL in adult patients with primary dysbetalipoproteinemia
  • Mean baseline: 1 mg/dL (range -40 to 72) in adult patients with primary hypertriglyceridemia
• HDL-C (High-Density Lipoprotein Cholesterol):
  • Mean baseline: 35.5 mg/dL in adult patients with primary dysbetalipoproteinemia
  • Mean baseline: -3 mg/dL (range -25 to 18) in adult patients with primary hypertriglyceridemia 2

From the Research

Patient's Lipid Levels

The patient's lipid levels are not directly stated in the provided studies. However, the studies discuss various factors that influence lipid levels and methods for managing hyperlipidemia.

• Dietary factors that influence lipid levels include:
  • Reducing intake of saturated and trans fats
  • Increasing intake of polyunsaturated and monounsaturated fats
  • Fortifying foods with plant stanols or sterols
  • Consuming one or two alcoholic drinks per day
  • Adopting a Portfolio, Mediterranean, low-carbohydrate, or low-fat diet 3
• Medications that can help manage lipid levels include:
  • Statin drugs to reduce low-density lipoprotein (LDL)-cholesterol (LDL-C) and cardiovascular risk
  • Ezetimibe to supplement statin therapy or used alone in cases of statin intolerance
  • Inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) to reduce LDL-C and cardiovascular risk
  • Fenofibrate to reduce triglycerides and cardiovascular risk in patients with type 2 diabetes 4, 5, 6
• Lifestyle changes that can help manage lipid levels include:
  • Regular aerobic exercise
  • Brief physician counseling for motivated patients
  • Reducing intake of dietary cholesterol
  • Increasing intake of soluble fiber and soy protein
  • Eating fatty marine fish or taking marine-derived omega-3 fatty acid supplements 3, 7

Managing Hyperlipidemia

Managing hyperlipidemia involves a combination of dietary changes, medication, and lifestyle modifications. The goal is to reduce the risk of cardiovascular disease by lowering LDL-C and triglyceride levels.

• The National Lipid Association recommends nutrition interventions for adults with dyslipidemia, including:
  • Lowering LDL-C and non-high-density lipoprotein cholesterol
  • Restricting intakes of alcohol, added sugars, and refined starches
  • Increasing intakes of unsaturated fatty acids, plant proteins, and viscous fibers
  • Reducing adiposity for patients with overweight or obesity 7
• The European Atherosclerosis Society Task Force provides practical guidance for combination therapy for elevated LDL-C and/or triglycerides in high-risk and very-high-risk patients, including:
  • Statin-ezetimibe combination treatment
  • Adding a PCSK9 inhibitor if LDL-C levels remain high
  • Considering treatment with either a fibrate or high-dose omega-3 fatty acids for patients with mild to moderately elevated triglyceride levels 5