Lipid control

Treatment target

• The primary treatment target should be LDL-cholesterol (LDL-C). An alternative target is non-HDL-C (Total cholesterol minus HDL-cholesterol). Non-HDL is of special relevance for patients with high triglycerides, where LDL-C may be difficult to estimate.
• Other lipid measures that affect the risk but are not considered as treatment targets are Triglycerides (TG), HDL and lipoprotein(a) (Lp(a)).
• In addition, TG >1.7 mmol/L (150 mg/dL), HDL< 1.0 (40 mg/dL) for men 1.2 mmol/L (46 mg/dL) and Lp(a) above 50mg/100ml is associated with increased risk.

Treatment goal

Please visit the webpage Cardioprotective drugs: Statins & more for treatment goal  recommendations.

Intervention strategies

• Patients in secondary prevention are always at very high risk, and should be intensively treated to reach goals
• Unless untreated LDL-C is below 1.8 mmol/L, 70 mg/dL, statin treatment in adequate doses should be initiated
• Life style measures/recommendations should be the basis for treatment.
• In patients with acute coronary syndrome, intensive statin treatment should be initiated at an early stage, irrespective of LDL-C level
• If the goals are not reached with highest tolerated dose of potent statin, an add-on therapy with ezetimibe is recommended.

Lifestyle recommendations

Lifestyle changes should include all aspects of healthy living/a healthy lifestyle

• Diet
  Switch to a healthier diet improves plasma lipid levels
• Reduce saturated fat, trans-fat and sugar
• Increase intake of mono- and polyunsaturated fat (oil and fat fish)
• Increase dietary fibre 
• Weight
  Obesity or being overweight is associated with several risk factors such as high TG and low HDL.
• Weight loss reduces TG and increases HDL
• Exercise/Physical Activity
  Regular exercise and increased physical activity are essential for several aspects of lifestyle recommendation. It may also improve lipid levels.
• Physical activity reduces TG and increases HDL

Pharmacological treatment

Please visit the webpage Cardioprotective drugs: Statins & more for detailed recommendations. 

Statin side effects

Please visit the webpage Cardioprotective drugs: Statins & more for information on the Adverse Effects of Statins.

How to handle Statin side effects

• Stop statin treatment, and record symptoms then start treatment again and record symptoms
• Try another statin
• Lower the dose, and try high potency statin once or twice a week
• Give the highest tolerated dose combined with ezetimibe
• If no statin is tolerated, suggest ezetimibe, consider the combination with bile acid sequester
• Consider PCSK9 inhibitor if available

FLOW CHART: dyslipidaemia treatment strategy (1)