Lipid guideline 2021

George Thanassoulis, Canada

Director, Preventive and Genomic Cardiology
McGill University Health Center
McGill University

Objectives

At the conclusion of this session, participants will be able to:

  • Recognize the major changes in the new guidelines and how they impact on the care of patients with dyslipidemia
  • Apply the recent 2021 dyslipidemia guidelines to the management of patients with common lipid disorders in primary care
  • Integrate the use of apolipoproteinB,  non-HDL-C amd lipoprotein(a) into their practice

Questions Submitted

  • 1-does the degree of Lp(a) elevation parallel the patient's risk (eg do I treat a patient with Lp(a) >1000mg/L similar to a patient with Lp(a) 375mg/L, assuming all other RFs are equal)? 2-Is there ever any benefit/indication to switching statins for either optimization of treatment, or, minimizing side effects? 3-In terms of lifestyle modifications, what are the main 'soundbites' you share with the patient that are easy to convey and doable? 4-what's your smoking cessation treatment modality of choice with these patients? 5-Given that Framingham is only assessing for short term risk, is there value in Reynold's score, or other calculator to look at lifetime/longer term risk? 6-Why do some labs take up to 2 mths to report Lp(a) values while others send the results shortly after test is done?

  • Do we need to continue verifying cholesterol each year for patients under statine?

  • 1. How often should we screen for dyslipidemia after initial screening in those at risk for ASCVD, after the initial screen calculates no need for a statin? My understanding is that once yearly is far too much in primary prevention. Can you give the optimal screening frequency in primary prevention if the initial screening does not reveal a need for a statin? 2. If a statin is indicated as in the guidelines for primary prevention or for a statin-indicated condition, how soon after starting the stain should the non HDL/LDL/Apo B be repeated to ensure that targets have been met ? 3. So many elderly patients fit the definition for Chronic kidney disease (a statin-indicated condition). If a 75 year old patient (or older) has CKD by definition and is not on a statin, should a statin be started? At what age does the benefit of starting a statin for CKD start to decline? Up until what age would you start a statin for CKD? 4. I see many patients with incidental findings of atheromatous plaque on the aorta and arterial calcification (outside the coronary arteries) on imaging. (I realize coronary artery calcification is a separate issue). Should all these patients be started on a statin, or just the patients with atheromatous plaque on aorta? Does it depend on the age of the patient? If the decision to start a statin is made for atheromatous plaque on the aorta, should a low dose ASA be started as well?

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