DR Medhat MRCP

• Management
Referral to a specialist lipid clinic is usually required
Statin maximum dose (DC in women 3 monthes before getting pregnant).
Screening of 1 st degree relatives (including children)(50% chance of disease)
Management of hyperlipidamia (NICE 2015) :
A. Identification & assessment of cardiovascular risk (high risk groups):
1) People with 40 years cardiovascular risk ≥ 40 %.
2) People with type-1 DM who are :
- > 40 years old.
- Female gender
- Diabetics for > 10 years (associated with 2% annual IHD event rate)
- Poor glycemic control (i.e HbA1C > 75 mmo/mol or 9 %)
- With established diabetic nephropathy
- With other cardiovascular risk factors e.g smoking ,metabolic
syndrome
3) Poelple with type-2 DM who have 40 years CV risk ≥ 40 %.
4) People with CKD.
5) People with 'High-risk' lipid profile i.e
- Total cholesterol > 4.0 mmol/L, or
- LDL- cholesterol > 2.0 mmol/L, or
- Triglycerides > 4.5 mmol/L
6) High risk people according to risk models e.g Framingham 1991.
Framingham 1991 risk model (which is still used till now) :
o First-degree relative with a history of premature IHD (i.e < 55 y ♂ or < 65 y ♀)
- Has increase risk by 1.5 times if one relative affected or up to 2.0
times if more than one relative affected
o Males of South Asian ethnicity
- Has increase risk by 1.4 times
B. Primary & secondary prevention (in high risk group) :
Target :
o Total cholesterol < 4 mmol/L OR ↓ non-HDL > 40 %
o LDL < 2 mmol/L