The National Lipid Association (NLA) has released new recommendations for the management of dyslipidemia that incorporate the need for a multifaceted approach incorporating each patient risk and risk factors, rather than specific medication categories. The recommendations were published in the Journal of Clinical Lipidology.

The NLA panel expert panel found sufficient evidence for the following conclusions that guided the development of the recommendations:

  • An elevated level of cholesterol carried by circulating apolipoprotein (apo) B-containing lipoproteins (non–HDL-C and LDL-C, termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical arteriosclerotic cardiovascular disease (ASCVD) events.
  • Reducing elevated levels of these atherogenic cholesterol particles will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to be a result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies.
  • The intensity of risk-reduction therapy should generally be adjusted to the patient’s absolute risk for an ASCVD event.
  • Atherosclerosis is a process that often begins early in life and progresses for decades before resulting in a clinical ASCVD event. Therefore, both intermediate-term and long-term/lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies.
  • For patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk.
  • Non-lipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus.

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While drug therapy may be needed for those patients with sufficient risk, lifestyle modifications such as diet and exercise are also an important element of risk-reduction efforts regardless of whether or not drug therapy is utilized as part of the treatment plan. The panel’s consensus also emphasizes that non-HDL-C is a better primary target for treatment vs. the traditionally reported LDL-C and can be obtained in the non-fasting state without additional cost.

The use of statins in specific doses have the most supportive evidence from research in reducing cardiovascular risk in higher-risk patients, but physicians should use clinical judgment in determining the best dosage for individuals based on all risk factors.

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