Ziajka treatment 5.5x8.indd

Module 10
Module 11
Module 12
Module 13
Module 14
Module 15
Module 16
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
Lp(a) > 10 mg/dL
TMENT PLANS
ATIENT TREA
ve two or more major risk factors i.e.
Trigs > 150 mg/dL
Trigs > 150 mg/dL
Trigs > 150 mg/dL
Trigs > 150 mg/dL
wn cardiovascular disease or diabetes) calcula tients use different risk factor tables).
SELECTING OPTIMAL P
HDL < 40 mg/dL
HDL < 40 mg/dL
atients:
t female and male pa High Risk (V Intermedia Low Risk atients:
LDL > Threshold LDL
tients with 2 or more major risk factors (but no kno Low Risk P Patients with 0 or 1 major risk factor are considered lo
Multiple Risk F For pa Point Score (Note tha If their 10 year risk is:
Any person with elevated LDL cholesterol or other form of hyperlipidemia should undergo clinical or laboratory assess- ment to rule out secondary dyslipidemia before initiation of lipid-lowering therapy. Causes of secondary dyslipidemia in- clude: diabetes, hypothyroidism, obstructive liver disease, chronic renal failure, & drugs that can alter cholesterol levels.
Lifestyle/Diet/non-pharmacological intervention: NCEP TLC diet with ad- ■ Lifestyle/Diet/non-pharmacological intervention ditional carbohydrate restriction & alcohol avoidance ■ If not contraindicated use a drug that improves insulin sensitivity in diabet- ■ If overweight target 5 to 10% reduction in body weight ics (i.e. agent in the metformin or “glitazone” class) ■ Fenofi brate 160 mg qD with food ■ Gemfi brozil 600 mg bid ■ Aggressive diet, if diet unsuccessful consider fenofi brate 160 mg qD ■ If unable to shift LDL density consider lowering target [LDL] to less than ■ Statins (rosuvastatin or atorvastatin) Lower Triglycerides and Lp(a)—See Module 3, 2 ■ Target [trig]< 100mg/dl with aggressive diet. If diet unsuccessful consider fenofi brate 160 mg qD and/or niacin 1 to 4 grams per day ■ Consider specifi c drug therapy to shift LDL density niacin 1-2 grams per Target [total HDL] > 45 mg/dl in men / >55 mg/dl in women ■ If unable to shift LDL density consider lowering target [LDL] to <70mg/dl ■ Modest EtOH intake (equivalent of ~2 ounces pure EtOH per day) if not ■ Smoking cessation and increase aerobic activity ■ Moderate EtOH consumption (equivalent of ~2 ounces pure EtOH/day) if ■ Rosuvastatin 10 mg qD ■ Simvastatin 40 or 80 mg qD and/or In high risk patients unresponsive to efforts to raise HDL consider lowering ■ rosuvastatin 10 mg qD or ■ simvastatin 40 or 80 mg qD ■ If unable to raise [HDL2] consider lowering target [LDL] to less than 70 Raise HDL & Lower Lp(a)—See Module 5, 2 Lower Triglycerides & Raise HDL—See Module 3, 5 ■ Rule out potential cause of very low fat, high carbohydrate diet Lower Triglycerides, Raise HDL, & Lower Lp(a)—See Module 3, 5, 2 ■ Drug therapy with fenofi brate 160 mg qD Lifestyle / Diet / non-pharmacological intervention: ■ If overweight target 5 to 10% reduction in body weight ■ Drug therapy with combined low dose statin and low dose niacin ■ If LDL exceeds NCEP drug initiation level or if patient extremely high risk ■ Lifestyle/Diet/non-pharmacological intervention: with additional carbohy- ■ Select agent & initial dose based on %LDL reduction needed to get to goal ■ If overweight target 5-10% reduction in body weight ■ Consider use of: fenofi brate 160 mg qD &/or niacin 1-4 g/day &/or Ω-3- If unable to get to goal on monotherapy consider combination therapy: Module 10
If patient is an African-American no treatment needed ■ Thyroid hormone replacement to normalize TSH if hypothyroid Module 11
■ ACE/ARB therapy in diabetics with microalbuminuria / proteinuria Lower LDL & Triglycerides—See Module 9, 3 Lifestyle/Diet/non-pharmacological intervention: ■ moderate EtOH consumption (equivalent of ~2 ounces pure EtOH per day) Module 12
Lower LDL, Triglycerides & Lp(a)—See Module 9, 3, 2 ■ aspirin 81 mg qD if not contraindicated■ restriction of dietary trans-fatty acids Module 13
Lower LDL & Raise HDL—See Module 9, 5 Module 14
Lower LDL, Raise HDL, & Lower Lp(a)—See Module 9, 5, 2 Alternative approach to lowering [Lp(a)] is to lower the [LDL] below current NCEP guidelines {Lp(a) loses predictive value if [LDL]<70 mg%} Module 15
If the patient is on a statin consider the use of rosuvastatin, simvastatin or Lower LDL & Triglycerides & Raise HDL—See Module 9, 3, 5 Module 16
Lower LDL & Triglycerides, Raise HDL, & Lower Lp(a)—See Module 9, 3, 5, 2 Note, in some cases contraindications may exist so use caution and refer to PDR to make fi nal treatment recommendations.
Review Module 1 in al patients. Treat Modules in order listed.

Source: http://www.atherotech.us/images/vapliterature/pdfs/ziajka_treatment_pocket_guide.pdf