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Management of dyslipidemia: a clinical case based approach

ESC webinar

20/10/2011 00:00 20/10/2011 00:00 Europe/Paris Management of dyslipidemia: a clinical case based approach

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European Society of Cardiology DD/MM/YYYY
Cardiovascular Disease in Primary Care
Risk Factors and Prevention

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Course details

Speakers:  Z. Reiner and G. De Backer

Z. Reiner and G. De Backer will discuss, one after the other, some aspects of the guidelines focusing on a number of relevant clinical cases.
After an introduction of approximately 5 minutes to the topic, each speaker will focus on a number of relevant clinical cases. The cases will be submitted to the participants in the form of live “MCQs” (multiple choice question) in order to allow them to assess their knowledge. Then the results will be displayed and discussed in interaction with the audience.

Reading list

Guidelines on Management of Dyslipidemia
Publication in European Heart Journals

The experts answer your questions

Question Answer
After an acute coronary syndrome and in presence of normal cholesterol levels, for how long should statin treatment be continued? which statin should be used and which dosage in this situation? What is a ‘normal’ cholesterol? Anyhow, ALL patients who have suffered an acute coronary syndrome should receive a statin for the rest of their life irrespective of the starting value; given the actual scientific knowledge we should give them a statin at a dosage that keeps LDL-C < 70 mg/dL ( < 1.8 mmol/L)
If a patient with a primary prevention with LDL-C190mg/dl  is taking a statin and the liver enzymes increases more than x3  what to do then? See table 33 in the guidelines: If values rise to >=3xULN:
-stop statin or reduce dose; recheck liver enzymes within 4-6 weeks
-cautious reintroduction of therapy may be considered after ALT has returned to normal
Does very high HDL level (i.e. >80) have any adverse effect? In the meta-analysis of the Emerging Risk factors Collaboration ( JAMA 2009 302:1993) concentration of HDL-C was strongly associated with CHD risk in an approximately log-linear manner, independent of other risk factors; there was modest heterogeneity among the contributing studies; from the curves it looks as if the “protective “ effect of elevated HDL-C is less strong compared  to the ‘deleterious ‘ effect of low HDL-C levels
Is there not a relative risk chart in SCORE for a single high risk factor for the younger patients? Yes, there is a relative risk chart presented in the guidelines ( figure 3) with the following comments:
“A particular problem relates to young people with high levels of risk factors; a low absolute risk may conceal a very high relative risk requiring intensive lifestyle advice. Therefore a relative risk chart has been added to the absolute risk charts to illustrate that, particularly in younger persons, lifestyle changes can reduce relative risk substantially as well as reducing the increase in absolute risk that will occur with ageing .”