hyperlipdemi

1. Management of specific
conditions
• Treatment of elevated triglycerides:
– when TGS > 500 then need to lower triglycerides
first to prevent pancreatitis.
– Otherwise need to reach LDL goal first, then non-
HDL goal (LDL goal + 30 for VLDL).
– Increase physical activity, intensify weight
management first, then use fibrates or nicotinic
acid to reduce VLDL and triglycerides.

2. The Management of Specific
Conditions
• Any three of the following:
– 1. Abdominal Obesity
• Waist circumference ( >40 in M, >35 in F)
– 2. Triglycerides >150mg/dl
– 3. HDL Cholesterol
• <40 mg/dl in M, <50mg/dl in F
– 4. Blood Pressure >130/>85 mmHg
– 5. Fasting Glucose >110mg/dl
4. The Metabolic Syndrome:

3. Treatment of the Metabolic Syndrome:
• Recognized as secondary target of risk
reduction therapy after LDL cholesterol.
– 1. Treat underlying causes
• intensify weight management
• increase physical activity
– 2. Treat risk factors if they persist after
lifestyle therapies.
• Treat HTN, Use ASA for CHD, Treat increased
triglycerides &/or Low HDL.
The Management of Specific Conditions

4. Interventions to Improve
Adherence
• Simplify medication regimes.
• Use good counseling techniques with patients.
• Involve patients and their families in their
care.
• Increase visits / access to achieve goals.
• Reinforce and reward compliance.
• Multidisciplinary approach within the clinic.
• Physician reminders to prompt attention to
lipid management.

5. THE USE OF OMEGA-3 (EPA
+DHA) IN
HYPERTRIGLYCERIDEMIA,
ESC 2019

6. Skulas-Ray AC et al. Circulation 2019 Aug 19
Prescription n-3 FAs (EPA+DHA or EPA-
only) at a dose of 4 g/d (>3 g/d total
EPA+DHA) are an effective and safe
option for reducing triglycerides as
monotherapy or as an adjunct to other
lipid-lowering agents.
All prescription agents appear comparably
effective, but head-to-head comparisons
are lacking
AHA ScienceAdvisory

7. AHA Science Advisory 2019
Concerns have been raised that DHA-containing prescription agents
may raise LDL-C in patients with HTG. We identified 9 trials of
patients with HTG that reported effects on LDL-C with 4 g/d of DHA
containing prescription n-3 FA (8 studies of O3AEE and 1 study of
O3CA).
In 8 of these 9 studies, there was no change in LDL-C versus placebo
(4 of which used n-3 FA as an adjunct to statin therapy), whereas in 1
study, the median LDL-C was marginally increased by 3.5% versus
placebo (P=0.052).31 This is similar to the change reported in
REDUCE-IT, with a median increase in LDL-C of 3.1% from baseline
(P<0.001) for EPA-only.
Skulas-Ray AC et al. Circulation 2019 Aug 19

8. The use of Omega-3(EPA+DHA) in Hypertriglyceridemia, ESC2019

9. Take Home Messages
• Focus on Multiple Risk Factors
• New Lipid and Lipoprotein
Classification
• New recommendations for screening
• More intensive tender loving care
• New strategies for compliance

10. THANK YOU