(HealthDay News) — In a synopsis of the 2020 updated clinical practice guideline from the US Department of Veterans Affairs and the US Department of Defense, published online in the Annals of Internal Medicine, recommendations are presented for the management of dyslipidemia to reduce cardiovascular disease (CVD) risk.
Patrick G. O’Malley, MD, MPH, from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and colleagues developed key questions, evaluated the literature, and developed 27 recommendations and a simple algorithm for managing dyslipidemia to reduce CVD in adults.
The recommendations address targeting of statin dose, additional tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition. The authors suggest against offering a CVD risk assessment more frequently than every 5 years for primary prevention in patients aged younger than 40 years who are not receiving statins and have not developed new CVD risk factors. A 10-year risk calculator is suggested for CVD risk assessment in primary prevention. Moderate-dose statin therapy is recommended for primary prevention for patients with a 10-year CVD risk ≥12%, a low-density lipoprotein cholesterol level ≥4.9 mmol/L, or diabetes. At least moderate statin doses are recommended for secondary prevention. Recommended lifestyle interventions include an exercise-based cardiac rehabilitation program for patients with recent coronary heart disease.
“We present a pragmatic, patient-centered approach to managing lipid levels to reduce CVD risk, applying evidence for treatment that is concordant with the risk in the populations studied,” the authors write.
O’Malley PG, Arnold MJ, Kelley C, et al. Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2020 updated US department of veterans affairs and US department of defense clinical practice guideline. Ann Intern Med. doi:10.7326/M20-4648
Reston JT, Buelt A, Donahue MP, et al. Interventions to improve statin tolerance and adherence in patients at risk for cardiovascular disease. Ann Intern Med. doi:10.7326/M20-4680
Bailey AL, Campbell CL. The US department of veterans affairs and US department of defense guideline for the management of dyslipidemia: Is moderate risk reduction enough? Ann Intern Med. doi:10.7326/M20-6125