Treatment and Management Goals of Dyslipidemia (Lipids) Chart

Dyslipidemia or dyslipidaemia is an abnormal amount of lipids (e.g. cholesterol and/or fat) in the blood. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood, often due to diet and lifestyle. The prolonged elevation of insulin levels can lead to dyslipidemia. Increased levels of O-GlcNAc transferase (OGT) are known to cause dyslipidemia.

LIPIDS
• Lowering LDL-C is the main goal of treatment; once the LDL-C goal is reached, other lipid and non-lipid risk factors can be treated. Therapeutic Lifestyle Changes (TLC) are first-line therapy; reserve drug therapy for higher risk patients. ContinueTLC for ≥3 months before starting drug therapy; use drug therapy with—not instead of—TLC. • If there is evidence of coronary heart disease (CHD) or CHD risk equivalents, do lipoprotein analysis. • If there is no evidence of CHD, but there are 2 or more major risk factors for CHD other than LDL-C, use Framingham scoring system to identify those with a 10-year risk. See www.nhlbi.nih.gov for worksheets to determine 10-year risk.
LDL-C GOALS
Risk Category	LDL-C goal	LDL-C level to start TLC	LDL-C level to consider drug therapy
CHD or risk equivalents (10-year risk >20%) • ≥45yrs male; ≥55yrs female • Smoking • HTN or taking HTN therapy                            • HDL ≤35mg/dL • Diabetes • Family history of CHD	<100 mg/dL (optional goal of <70 mg/dL)	≥100 mg/dL	≥100 mg/dL <100 mg/dL: consider initiating or intensifying LDL-C lowering therapy, treat other risk factors, or use other lipid-modifying drugs (nicotinic acid or fibrates) if high TG or low HDL-C
2+ risk factors (10-year risk 10 to 20%)	<130 mg/dL (optional goal of <100 mg/dL)	≥130 mg/dL	≥130 mg/dL 100–129 mg/dL: consider initiating LDL-C lowering therapy optional
2+ risk factors (10-year risk <10%)	<130 mg/dL	≥130 mg/dL	≥160 mg/dL
0 to 1 risk factor (10-year risk assessment not necessary)	<160 mg/dL	≥160 mg/dL	≥190 mg/dL 160–189 mg/dL: drug therapy optional; consider if single severe risk factor, multiple life-habit and/or emerging risk factors, or 10-year risk nearly 10%
LDL-C vs. Non-HDL-C Goals*
• In high-risk persons, consider drug therapy to achieve non-HDL-C goal. The non-HDL-C goal can be achieved by intensifying therapy with an LDL-lowering drug or by cautiously adding nicotinic acid or fibrate.
Risk Category	LDL-C Goal		Non-HDL-C Goal
CHD and CHD risk equivalent (10-year risk >20%)	<100 mg/dL		<130 mg/dL
2+ risk factors and 10-year risk ≤20%	<130 mg/dL		<160 mg/dL
0 to 1 risk factor	<160 mg/dL		<190 mg/dL
*Non-HDL-C = Total-C − HDL-C
Management of Low HDL-C
• Low HDL-C (<40 mg/dL) is a strong independent predictor of CHD. The primary target of therapy is LDL-C. There is not a specific goal for raising HDL-C; after LDL-C goal is reached, emphasize weight reduction and increased physical activity, and modifying non-HDL-C if TG is also elevated. • If triglycerides are <200 mg/dL (see below), consider using drugs to raise HDL-C (fibrates or nicotinic acid).
Management of Elevated TG
• Elevated serum triglycerides (TG) is an independent risk factor for CHD. For all patients with high TG, the primary goal of therapy is to achieve the target goal for LDL-C.
Classification	Serum TG level	In addition to achieving target LDL-C goal:
Normal	<150 mg/dL
Borderline-high	150–199 mg/dL	• Reduce weight and increase physical activity
High	200–499 mg/dL	• Non-HDL-C is secondary target (intensify LDL-C lowering therapy or add nicotinic acid or fibrate cautiously).
Very High	≥500 mg/dL	• Initial aim is to prevent acute pancreatitis through TG lowering by using very low fat diets, weight reduction, increased physical activity, and a TG lowering drug (fibrate or nicotinic acid). After TG levels ≤500 mg/dL, focus on lowering LDL-C.