The Living Guidelines: UA/NSTEMI Recommendations for Lipid Management Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines
1. The following lipid recommendations are beneficial:


 * a. Lipid management should include assessment of a fasting lipid profile for all patients, within 24 h of hospitalization. (Level of Evidence: C)
 * b. Hydroxymethyl glutaryl-coenzyme A reductase inhibitors (statins), in the absence of contraindications, regardless of baseline LDL-C and diet modification, should be given to post-UA / NSTEMI patients, including post revascularization patients. (Level of Evidence: A)
 * c. For hospitalized patients, lipid-lowering medications should be initiated before discharge. (Level of Evidence: A)
 * d. For UA / NSTEMI patients with elevated LDL-C (≥100 mg/dL), cholesterol lowering therapy should be initiated or intensified to achieve an LDL-C of <100 mg/dL. (Level of Evidence: A) Further titration to <70 mg/dL is reasonable (Class IIa, Level of Evidence: A)
 * e. Therapeutic options to reduce non HDL-C are recommended, including more intense LDL-C lowering therapy. (Level of Evidence: B)
 * f. Dietary therapy for all patients should include reduced intake of saturated fats (to <7% of total calories), cholesterol (to <200 mg/d), and trans fat (to <1% of energy). (Level of Evidence: B)
 * g. Promoting daily physical activity and weight management are recommended. (Level of Evidence: B)

2. Treatment of triglycerides and non-HDL-C is useful, including the following:


 * a. If triglycerides are 200-499 mg/dL, non HDL-C should be <130 mg/dL. (Level of Evidence: B)
 * b. If triglycerides are ≥500 mg/dL, therapeutic options to prevent pancreatitis are fibrate or niacin before LDL-lowering therapy is recommended. It is also recommended that LDL-C be treated to goal after triglyceride lowering therapy. Achievement of a non HDL-C <130 mg/dL (i.e., 30 mg/dL greater than LDL-C target) if possible is recommended. (Level of Evidence: C)