The Living Guidelines: Lipid Management Polling Results for CLASS I Guidelines

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'''Goal: LDL-C substantially <100 mg/dL. (If triglycerides are ≥200 mg/dL, non–HDL-C should be <130 mg/dL)'''

1. A fasting lipid profile should be assessed in all patients and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiation of lipid lowering medication is indicated as recommended below before discharge according to the following schedule:


 * a. LDL-C should be < 100 mg/dL. (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Recommendation 1a for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * b. Further reduction of LDL-C to <70 mg/dL is reasonable. (Class IIa Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Recommendation 1b for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * c. If baseline LDL-C is ≥100 mg/dL, LDL-lowering drug therapy should be initiated. (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Recommendation 1c for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * d. If on-treatment LDL-C is ≥100 mg/dL, intensify LDL lowering drug therapy (may require LDL lowering drug combination) is recommended. (Class I Level of Evidence: A)

 AHA / ACC 2007 PCI Guidelines Recommendation 1d for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * e. If baseline LDL-C is 70 to 100 mg/dL, it is reasonable to treat to LDL-C <70 mg/dL. (Class IIa Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 1e for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * f. If triglycerides are ≥150 mg/dL or HDL-C is <40 mg/dL, weight management, physical activity, and smoking cessation should be emphasized. (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 1f for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * g. If triglycerides are 200 to 499 mg/dL, non–HDL-C target should be less than 130 mg/dL. (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 1g for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * h. If triglycerides are 200 to 499 mg/dL, further reduction of non–HDL-C to <100 mg/dL is reasonable. (Class IIa Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 1h for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III

2. Therapeutic options to reduce non–HDL-C include:


 * a. More intense LDL-C–lowering therapy is indicated. (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 2a for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * b. Niacin (after LDL-C–lowering therapy) can be beneficial. (Class IIa Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 2b for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III


 * c. Fibrate therapy (after LDL-C–lowering therapy) can be beneficial. (Class IIa Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Recommendation 2c for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III

3. If triglycerides are ≥500 mg/dL, therapeutic options indicated and useful to prevent pancreatitis are fibrate or niacin before LDL lowering therapy, and treat LDL-C to goal after triglyceride-lowering therapy. Achieving a non–HDL-C of <130 mg/dL is recommended. (Class I Level of Evidence: C)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 3 for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III

4. Starting dietary therapy is recommended. Reduce intake of saturated fats (to <7% of total calories), trans fatty acids, and cholesterol (to <200 mg/day). (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 4 for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III

5. Promotion of daily physical activity and weight management is recommended. (Class I Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Class I Recommendation 5 for Lipid Management should be CLASS I CLASS IIa CLASS IIb CLASS III