Tags

Type your tag names separated by a space and hit enter

2017 Taiwan lipid guidelines for high risk patients.
J Formos Med Assoc. 2017 Apr; 116(4):217-248.JF

Abstract

In Taiwan, the prevalence of hyperlipidemia increased due to lifestyle and dietary habit changes. Low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) are all significant predicting factors of coronary artery disease in Taiwan. We recognized that lipid control is especially important in patients with existed atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), ischemic stroke and peripheral arterial disease (PAD). Because the risk of ASCVD is high in patients with diabetes mellitus (DM), chronic kidney disease (CKD) and familial hypercholesterolemia (FH), lipid control is also necessary in these patients. Lifestyle modification is the first step to control lipid. Weight reduction, regular physical exercise and limitation of alcohol intake all reduce triglyceride (TG) levels. Lipid-lowering drugs include HMG-CoA reductase inhibitors (statins), cholesterol absorption inhibitors (ezetimibe), proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, nicotinic acids (niacin), fibric acids derivatives (fibrates), and long-chain omega-3 fatty acids. Statin is usually the first line therapy. Combination therapy with statin and other lipid-lowering agents may be considered in some clinical settings. For patients with acute coronary syndrome (ACS) and stable CAD, LDL-C < 70 mg/dL is the major target. A lower target of LDL-C <55 mg/dL can be considered in ACS patients with DM. After treating LDL-C to target, non-HDL-C can be considered as a secondary target for patients with TG ≥ 200 mg/dL. The suggested non-HDL-C target is < 100 mg/dL in ACS and CAD patients. For patients with ischemic stroke or transient ischemic attack presumed to be of atherosclerotic origin, statin therapy is beneficial and LDL-C < 100 mg/dL is the suggested target. For patients with symptomatic carotid stenosis or intracranial arterial stenosis, in addition to antiplatelets and blood pressure control, LDL-C should be lowered to < 100 mg/dL. Statin is necessary for DM patients with CV disease and the LDL-C target is < 70 mg/dL. For diabetic patients who are ≥ 40 years of age, or who are < 40 years of age but have additional CV risk factors, the LDL-C target should be < 100 mg/dL. After achieving LDL-C target, combination of other lipid-lowering agents with statin is reasonable to attain TG < 150 mg/dL and HDL-C >40 in men and >50 mg/dL in women in DM. LDL-C increased CV risk in patients with CKD. In adults with glomerular filtration rate (GFR) < 60 mL/min/1.73m2 without chronic dialysis (CKD stage 3-5), statin therapy should be initiated if LDL-C ≥ 100 mg/dL. Ezetimibe can be added to statin to consolidate the CV protection in CKD patients. Mutations in LDL receptor, apolipoprotein B and PCSK9 genes are the common causes of FH. Diagnosis of FH usually depends on family history, clinical history of premature CAD, physical findings of xanthoma or corneal arcus and high levels of LDL-C. In addition to conventional lipid lowering therapies, adjunctive treatment with mipomersen, lomitapide, or PCSK9 inhibitors become necessary to further reduce LDL-C in patients with FH. Overall, these recommendations are to help the health care professionals in Taiwan to treat hyperlipidemia with current scientific evidences. We hope the prescription rate of lipid lowering drugs and control rate of hyperlipidemia in high risk patients could be increased by implementation of the clinical guidelines. The major purpose is to improve clinical outcomes of these high risk patients through the control of hyperlipidemia.

Authors+Show Affiliations

Division of Cardiology, Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.Division of Cardiology, Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.Division of Cardiology, Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.Departments of Internal Medicine and Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.Departments of Internal Medicine and Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.Departments of Internal Medicine and Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei, Taiwan.Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.Departments of Internal Medicine and Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. Electronic address: hungi.yeh@msa.hinet.net.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28242176

Citation

Li, Yi-Heng, et al. "2017 Taiwan Lipid Guidelines for High Risk Patients." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 116, no. 4, 2017, pp. 217-248.
Li YH, Ueng KC, Jeng JS, et al. 2017 Taiwan lipid guidelines for high risk patients. J Formos Med Assoc. 2017;116(4):217-248.
Li, Y. H., Ueng, K. C., Jeng, J. S., Charng, M. J., Lin, T. H., Chien, K. L., Wang, C. Y., Chao, T. H., Liu, P. Y., Su, C. H., Chien, S. C., Liou, C. W., Tang, S. C., Lee, C. C., Yu, T. Y., Chen, J. W., Wu, C. C., & Yeh, H. I. (2017). 2017 Taiwan lipid guidelines for high risk patients. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 116(4), 217-248. https://doi.org/10.1016/j.jfma.2016.11.013
Li YH, et al. 2017 Taiwan Lipid Guidelines for High Risk Patients. J Formos Med Assoc. 2017;116(4):217-248. PubMed PMID: 28242176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 2017 Taiwan lipid guidelines for high risk patients. AU - Li,Yi-Heng, AU - Ueng,Kwo-Chang, AU - Jeng,Jiann-Shing, AU - Charng,Min-Ji, AU - Lin,Tsung-Hsien, AU - Chien,Kuo-Liong, AU - Wang,Chih-Yuan, AU - Chao,Ting-Hsing, AU - Liu,Ping-Yen, AU - Su,Cheng-Huang, AU - Chien,Shih-Chieh, AU - Liou,Chia-Wei, AU - Tang,Sung-Chun, AU - Lee,Chun-Chuan, AU - Yu,Tse-Ya, AU - Chen,Jaw-Wen, AU - Wu,Chau-Chung, AU - Yeh,Hung-I, AU - ,, Y1 - 2017/02/24/ PY - 2016/09/21/received PY - 2016/11/26/accepted PY - 2017/3/1/pubmed PY - 2017/9/12/medline PY - 2017/3/1/entrez KW - Taiwan KW - guidelines KW - high risk KW - hyperlipidemia KW - statin SP - 217 EP - 248 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J Formos Med Assoc VL - 116 IS - 4 N2 - In Taiwan, the prevalence of hyperlipidemia increased due to lifestyle and dietary habit changes. Low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) are all significant predicting factors of coronary artery disease in Taiwan. We recognized that lipid control is especially important in patients with existed atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), ischemic stroke and peripheral arterial disease (PAD). Because the risk of ASCVD is high in patients with diabetes mellitus (DM), chronic kidney disease (CKD) and familial hypercholesterolemia (FH), lipid control is also necessary in these patients. Lifestyle modification is the first step to control lipid. Weight reduction, regular physical exercise and limitation of alcohol intake all reduce triglyceride (TG) levels. Lipid-lowering drugs include HMG-CoA reductase inhibitors (statins), cholesterol absorption inhibitors (ezetimibe), proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, nicotinic acids (niacin), fibric acids derivatives (fibrates), and long-chain omega-3 fatty acids. Statin is usually the first line therapy. Combination therapy with statin and other lipid-lowering agents may be considered in some clinical settings. For patients with acute coronary syndrome (ACS) and stable CAD, LDL-C < 70 mg/dL is the major target. A lower target of LDL-C <55 mg/dL can be considered in ACS patients with DM. After treating LDL-C to target, non-HDL-C can be considered as a secondary target for patients with TG ≥ 200 mg/dL. The suggested non-HDL-C target is < 100 mg/dL in ACS and CAD patients. For patients with ischemic stroke or transient ischemic attack presumed to be of atherosclerotic origin, statin therapy is beneficial and LDL-C < 100 mg/dL is the suggested target. For patients with symptomatic carotid stenosis or intracranial arterial stenosis, in addition to antiplatelets and blood pressure control, LDL-C should be lowered to < 100 mg/dL. Statin is necessary for DM patients with CV disease and the LDL-C target is < 70 mg/dL. For diabetic patients who are ≥ 40 years of age, or who are < 40 years of age but have additional CV risk factors, the LDL-C target should be < 100 mg/dL. After achieving LDL-C target, combination of other lipid-lowering agents with statin is reasonable to attain TG < 150 mg/dL and HDL-C >40 in men and >50 mg/dL in women in DM. LDL-C increased CV risk in patients with CKD. In adults with glomerular filtration rate (GFR) < 60 mL/min/1.73m2 without chronic dialysis (CKD stage 3-5), statin therapy should be initiated if LDL-C ≥ 100 mg/dL. Ezetimibe can be added to statin to consolidate the CV protection in CKD patients. Mutations in LDL receptor, apolipoprotein B and PCSK9 genes are the common causes of FH. Diagnosis of FH usually depends on family history, clinical history of premature CAD, physical findings of xanthoma or corneal arcus and high levels of LDL-C. In addition to conventional lipid lowering therapies, adjunctive treatment with mipomersen, lomitapide, or PCSK9 inhibitors become necessary to further reduce LDL-C in patients with FH. Overall, these recommendations are to help the health care professionals in Taiwan to treat hyperlipidemia with current scientific evidences. We hope the prescription rate of lipid lowering drugs and control rate of hyperlipidemia in high risk patients could be increased by implementation of the clinical guidelines. The major purpose is to improve clinical outcomes of these high risk patients through the control of hyperlipidemia. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/28242176/2017_Taiwan_lipid_guidelines_for_high_risk_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0929-6646(16)30430-2 DB - PRIME DP - Unbound Medicine ER -