Table 4
Dyslipidemia in Patients with Human Immunodeficiency virus (HIV)
  • HIV is an important ASCVD risk factor that should be considered equivalent to one additional ASCVD risk factor
  • Improved HIV care has led to increased survival, but ASCVD risk is increasing
  • Patients not receiving ART are at increased risk possibly due to immune-mediated factors
  • Patients receiving ART are at increased risk, possibly due to immune-mediated factors, insulin resistance, hyperglycemia, elevated triglycerides, and low HDL-C
  • No valid 10-year score exists specifically applying to patients with HIV
  • Statins are considered first-line treatment, but may lead to drug-drug interactions with ART regimens; less potential for interaction with concomitant rosuvastatin, pravastatin, or pitavastatin
  • Statins generally well tolerated in absence of drug-drug interactions; some evidence of increased risk of diabetes mellitus

ASCVD=atherosclerotic cardiovascular disease; HDL-C=high density lipoprotein cholesterol; LDL-C=low density lipoprotein cholesterol; ART=antiretroviral therapy

Table 5

Dyslipidemia in Patients with Inflammatory Conditions

  • ASCVD is leading cause of death among patients with autoimmune diseases (eg, RA and SLE)
  • ASCVD risk calculators are inaccurate predictors
  • The United Kingdom-based QRISK2 is only ASCVD risk calculator incorporating RA as a variable
  • Reynolds Risk Score includes CRP but may underestimate risk in patients with inflammatory diseases
  • Patients with RA may have lower LDL-C levels than general population, despite increased ASCVD risk
  • LDL-C may be decreased during acute flares of RA, so are better measured when the disease is stabilized
  • Statin therapy is treatment of choices for hypercholsterolemic patients

ASCVD=atherosclerotic cardiovascular disease; HDL-C=high density lipoprotein cholesterol; LDL-C=low density lipoprotein cholesterol; RA=rheumatoid arthritis; SLE=systemic lupus erythematosus.

Table 6

Selected Recommendations: Nutrition and Physical Activity

Medical nutrition for dyslipidemia
  • <7%saturated fat
  • <200 mg/day dietary cholesterol
  • Avoidance of trans fat
  • Limited proportion of refined carbohydrates/simple sugars
  • Relatively high proportion of vegetables, fruits, legumes, nuts, fish, low fat dairy, lean meat, unsaturated oils
  • Viscous fiber 5–10g/day
  • Plant sterols/stanols 2–3g/day

Physical activity

  • Triglyceride levels may be reduced by 4%–37% through exercise training volumes of 1200-2200kcal/week (eg, 15–20 miles/week of brisk walking or jogging).
  • HDL-C levels may be increased by 2%–8% and LDL-C levels may be reduced by up to 7% with this regimen

HDL-C=high density lipoprotein cholesterol; LDL-C=low density lipoprotein cholesterol

Table 7

Improving Adherence

  • Adherence is the result of individual, social, and environmental factors, requiring broad-based interventions to address complexity of these challenges
  • Systems approaches and removal of organizational barriers necessary
  • Team-based self-management support, outreach via text, phone, or messaging, electronic prescribing, lower prescription copays, and less-frequent prescription refills may be helpful
  • Identifying and treating nonadherence may require a multidisciplinary team
  • Simplify treatment regimen, provide clear education, engage patients in decision-making, address barriers, improve health literacy, assess/evaluate adherence with every patient encounter
  • Health-information technologies (eg, HER-based decision support, alerts, dashboards and patient-level tools) can improve adherence