Hyperlipidemia management in healthy population

Cardiovascular disease (CVD) is the leading cause of death in our country .The primary prevention of CVD in healthy population is necessary to reduce the global cardiovascular burden.SCREENING :Dyslipidemia( fasting lipid profile to ensure the most precise lipid assessment is enough) in healthy population should be diagnosed and managed as early as possible to reduce the levels of LDL-C that may eventually increase later risk of CV event. In the absence of ASCVD risk factors, screen middle-aged individuals for dyslipidemia at least once every 1 to 2 years. More frequent lipid testing is recommended when multiple global ASCVD risk factors are present. Individuals should be screened for familial hypercholesterolemia (FH) when there is a family history of:-Premature ASCVD (definite MI or sudden death before age 55 years in father or other male first-degree relative, or before age 65 years in mother or other female first-degree relative) or-Elevated cholesterol levels (total, non-HDL and/ or LDL) consistent with FH.RISK ASSESSMENT :Guidelines Recommended that the 10-year risk of coronary events (high, intermediate, or low) SHOULD be assessed every 5 years and whenever a patient’s expected risk status changes for men and women aged 40 to 75 years using the modified FRS or others standard Risk chart to guide therapy to reduce major CV events. Other risk factors such as apoB - apoB/apoA1 ratio- hsCRP-LP-PLA2-CAC score and ….that enable personalized and optimal therapy may be assessed in special situation. The secondary Couse of dyslipidemias should be assessed in all patients.TREATMENT: The management of dyslipidemia requires a comprehensive strategy to control lipid levels and address associated metabolic abnormalities and modifiable risk factors such as hypertension, diabetes, obesity, cigarette smoking and pharmacotherapy as needed to achieve evidence based targets.The new guidelines clearly demonstrated improved outcomes using statin therapy in those with ASCVD and those at high risk of ASCVD, not based on LDL targets but rather LDL lowering without specific sex differences. Statin therapy is recommended as the primary pharmacologic agent on the basis of morbidity and mortality outcome trials. The studies showed Primary Prevention with Statins in the healthy, 40 to 75 years of age with an estimated 10-year ASCVD risk ≥ 7.5% or with primary LDL-C levels of 190 mg per dL or greater results 0.4% absolute risk reduction for all cause mortality and .43 % of cardiovascular mortality.244 patients needs to treat for 5 years to prevent one death and these patients should be treated with statin.children and adolescents older than 10 years who do not respond sufficiently to lifestyle modification, and Particularly for those satisfying the following criteria : LDL-C ≥190 mg/dL ,LDL-C ≥160 mg/dl and the presence of 2 or more cardiovascular risk factors, even after vigorous intervention should be treated with statin.PCSK9 inhibitors should be considered for use in combination with statin therapy for LDL-C lowering in individuals with FH.Follow-up and monitoring: lipid status should be re-assessed 6 weeks after therapy initiation and again at 6-weeks intervals until the treatment goal is achieved. While on stable lipid therapy, individuals should be tested at 6- to 12-month intervals (Or more frequent depend on individual adherence to therapy and lipid profile consistency) . Increased Patients compliance and systematic follow up is important. patients who take less than 80% of their statin dosed have a 45% relative increase in total mortality compared with more adherent patients.