hyperlipidemia monitoring and treatment

[LKPAC]

We treat a lot of dyslipidemia around here.  Use a lot of statins.  Get good results in most cases.

 

How often do you guys monitor these patients?  Once stable, do you check HFP and lipids annually, q 6 months?  More often for diabetics? What LDL goals do you follow?

 

I have my own numbers and standards, I just want to see what others are doing.  Do you have any science to support?  Thanks

[BruceBanner]

For primary prevention, I am hesitant to start a statin on anyone under 40. There just isn't enough data on long-term therapy for primary prevention, and the relative risk reduction is low enough that diet and omega supplementation are usually sufficient unless their lipids are WAY out of control.

 

For patients over 40 with established hyperlipidemia, I like to check them q 6 months, annually at the very longest.

 

Personally I use atorvastatin and rosuvastatin (crestor), as they seem to be well-tolerated and have the strongest effect on LDL, trigs, and HDL.

 

 

 

There is a lot of negative hype on statins and people often come in telling me they will 'never' take a statin. When I ask why, it's usually because they watched some Netflix documentary or know someone who had myalgias. The reality is, statins are one of the most studied drug classes of all time and there is no question they work, with relatively few adverse effects compared to other common drugs. The increased risk of DM is only about 0.5% absolute risk. In longitudinal RTC's about 1 in 5 new cases of DM was directly attributable to statin use. There has even been meta analyses done on statin adverse effects and most of them are no more likely to occur than with placebo.

 

As for the myalgias, they can happen but not typically at lower doses.

[cbrsmurf]

Statins are cheap, inexpensive, well-studied, and safe.  Risk-stratify, LDL should be the primary marker one looks at.  I would check lipids 6 mos after initiation of statin, and if everything looks good, you really don't have to check lipids ever again if the patient has no issues/low risk.  Check q1yr if secondary prevention or more frequent if risk factors/history.

[UGoLong]

We check the first time about 2 months after starting and then q6-12 months. The goals have moved a bit but we stick to the old 130/100/70 mg/dL LDL goals. If we have a well-controlled patient with recurring CAD, we'll do other tests.