Page 340 - fbkCardioDiabetes_2017

316 International Lipid Guidelines :
What Is Needed For Indians ?

dividualized patient care approach : assessing other ADA Recommendations : Diabetes Care , Supple-
lipid-mediated factors “residual risk” :TG-rich lipo- ment 1 January 2017 . Ref Table 6
proteins remnants , HDL-C , Non-HDL-C & Apo B
. Recommends LDL-C and other lipid measures for
monitoring efficacy, compliance, assessing residual Age Risk factors Recommended
risk and allow a greater scope for modifying individ- statin Intensity *
ual patient care by considering additional therapies < 40 years None None
if clinically warranted . ASCVD risk factor(s) *** Moderate or high
Table : 4 THE BAD : Comparison of International Guidelines ASCVD ASCVD High
40–75 years None Moderate
ACC/AHA ESC/EAS NLA IAS LAI ASCVD risk factors High
Targets      ASCVD High
ACS and LDL cholesterol Moderate plus
Lower is better      >50mg/dl in patients who - Ezetimibe
Scope for other ath- cannot tolerate high
erogenic lipids      dose statins
Scope for other LLT      > 75 years None Moderate
CKD as a high risk ASCVD risk factors Moderate or high
ASCVD
High
group √  
ACS and LDL cholesterol Moderate plus
Table : 5 THE UNCERTAIN : Comparison of International Guidelines: >50mg/dl Ezetimibe
patients who cannot tolerate
ACC/AHA ESC/EAS NLA IAS LAI high –dose statins
What to do at the ? ? ? ? ? * In addition to lifestyle therapy
Extremes of age ** ASCVD risk factors include LDL cholesterol > 100 mg/dl ,
Promot- high BP, smoking, and overweight and obesity and family history
A new risk calcu- ? ? ing JBS of premature ASCVD
lator ? 
3 score
AACE Guidelines for Dyslipidemia Management 2017:
Reducing the pri-
mary Prevention √ ? √ - √ ASCVD Risk Categories and LDL-C Treatment Goals. Ref : Table 7
threshold [For
Young] Category Non- Apo
Reducing the pri- Apo 10 year risk LDL-C HDL-c B [mg/
dl]
mary prevention ? - - ?
threshold (For  Progressive ASCVD
Old) Extreme including unstable
angina in patients after
What do our pa- ? ? ? ? ? Risk achieving an LDL-C
tients want √ <70 mg/dL
2016 ACC Expert Consensus Statement : This is a dif- Established clinical CV
ferent compared to ACC/AHA Guidelines 2013 . The disease in patients with <55 <80 <70
statement stressed the role of Non-statin therapies DM, < 55 < 80 < 70
for LDL-C lowering in the management of ASCVD CKD 3/4, or HeFH
risk . Non HDL-C thresholds are included in high risk History of premature
patients . Ezetimibe is preferred as the initial non sta- ASCVD (<55 male,
tin therapy . Colesevelam has a modest hypoglyce- <65 female)
mic effect that may be of benefit in some diabetic 2017 Focused Update of the 2016 ACC Expert Consensus
patients with fasting triglycerides <300 mg/dl or in Decision Pathway on the Role of Non-Statin Therapies for
patients who are ezetimibe intolerant . LDL-Cholesterol Lowering in the Management of Athero-
sclerotic Cardiovascular Disease Risk :
2016 European Guidelines on CVD prevention in clini-
cal practice : Total CV risk should guide the intensity In 2016, the American College of Cardiology published
of the intervention . Non HDL –c is included as a tar- the first expert consensus decision pathway (ECDP)
get . Non statin therapy mainly Ezetimibe is recom- on the role of non-statin therapies for low-density
mended . lipoprotein (LDL) –cholesterol lowering in the man-
agement of atherosclerotic cardiovascular disease

GCDC 2017