Transcript
Dr Subhasish Deb
Burdwan Medical College and Hospital
Department of General Medicine
2013 ACC/AHA BLOOD
CHOLESTEROL
GUIDELINES
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
No LDL targets
Only STATINS to be used
Identification of 4 groups to benefit from
statin
-only considers high quality RCT data
THE CRUX
Dr Subhasish Deb, BMCH
LDL TARGETS
(NCEP ATP III)
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
1. Cigarette smoking
2. HTN (BP>=140/90 or on medication)
3. Low HDL-C (<40mg/dl)
4. Family history of premature CHD
a) CHD in male 1` relative <55yrs
b) CHD in female 1` relative <65yrs
5. Age : Men>=45yrs, Women >=55yrs
HDL>=60mg/dl counts as a negative risk factor. Its
presence removes 1 risk factor from total count
MAJOR RISK FACTORS IN NCEP ATP III
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
ACC/AHA
Statin benefit groups
Dr Subhasish Deb, BMCH
GROUP 1
Pts with clinical ASCVD(ACS, h/o MI, stable angina,
Stroke, PVD of atherosclerotic
Orign)
GROUP 2
GROUP 3 GROUP 4
LDL >=190 mg/dl
• LDL 70-189mg/dl
• Age 45-75yrs
• Diabetic
• LDL 70-189mg/dl
• Age 45-75yrs
• 10yr ASCVD
Risk >=7.5 %
High Intensity Statins High Intensity Statins
Moderate Intensity Statins Moderate Intensity Statins
EXCEPTION: Moderate Intensity if AGE >75yrs
EXCEPTION: High Intensity if
ASCVD>7.5% Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
NYHA II- IV ischemic systolic
Heart Failure
Pts. On maintenance
hemodialysis
WHEN NOT TO “STATINZE”
Dr Subhasish Deb, BMCH
SAFETY
RECOMMENDATIONS
FOR STATIN USE
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
Dr Subhasish Deb, BMCH
Mr. Mondal, 54yr old, smoker on Tab
amlodipine 10 o.d had hemiplegia on right side.
His lipid profile shows:
Cholesterol 268
Trig 168
Hdl 35
Ldl 142
CASE 1
HIGH INTENSITY STATINDr Subhasish Deb, BMCH
Mrs Rehima Bibi, 34yr old non smoker on
amlodipine 5 and tab prazosin 5, grade V ckd
on H/d.
Cholesterol 268
Trig 168
Hdl 35
Ldl 198
CASE 2
NO STATIN
Dr Subhasish Deb, BMCH
48yrs old Mr. JD, non smoker non htn, on
metformin 500 b.d lipid profile shows:
Cholesterol 238
Trig 198
Hdl 30
Ldl 158
CASE 3
MODRATE INTENSITY
Dr Subhasish Deb, BMCH
Mr Roy, 50yrs smoker, alcoholic, BP= 150/90
with:
Cholesterol 238
Trig 198
Hdl 30
Ldl 158
CASE 4
MODERATE INTENSITY STATINAscvd Risk = 32.1%
Dr Subhasish Deb, BMCH
Thank YouTHANK YOU
Dr Subhasish Deb, BMCH
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