DrAlex_76
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Case 1 : A 50 yo man, with Hx of HTN and he is on Thiazides. LDL = 170 mg/dL.
Case 2 : A 45 yo man, with Hx of type II Diabetes, LDL 140 mg/dl.
What is the best appropriate next step in management of those 2 cases ?
Regards,
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| Ivonne
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Case 1: Risk factors:
Age>45, hypertension therefore this a patient with 2 risk factors and LDL of 170--------->LDL goal is <130------------->if LDL> 160----------->treatment to reach goal is life style modification + Medications
Case 2: DM is CAD equivalent--------------->LDL goal is <100---------------->if LDL>130---------->Same: lifestyle modification plus meds
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"Believe you can and you're half way there."
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| kpmle2
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Agree with ivonne about case 1.
Case 2 -- DM--CAD or risk equivalent--LDL goal <70
correct me if i am wrong.
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| nightflight1945
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Case 1 : 2 risk factrors and LDL>160 -----> medication needed , lifestyle modification and thiazide should be stopped and changed to another class because it has an adverse effect on LDL profile.The goal is <100 and medication should be started >160
Case 2 : CAD equivalent and the goal is <70 , medication should be started >130 , so medication and lifestyle modification
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| kpmle2
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nightflight1945 wrote:
Case 1 : 2 risk factrors and LDL>160 -----> medication needed , lifestyle modification and thiazide should be stopped and changed to another class because it has an adverse effect on LDL profile.The goal is <100 and medication should be started >160
LDL goal for 2 or more risk factors is <130.
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| DrAlex_76
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Case 1 : 2 risk factors, 1 adverse reaction of medication so LDL disorder Rx when LDL > 160 , in this case Medications and Stop Thiazide. Goal for LDL is lower than 130.
Case 2 : DM # CHD equivalent, so Rx when LDL > 130, goal to get LDL down to 100.
References http://www.aafp.org/afp/20020301/871.html
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| ngaybinhyen
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1). CHD or CHD risk equivalents*
- Goal <100 mg/dL
- Lifestyle Changes 100 mg/dL (All pts regardless of LDL)
- Drug 130 mg/dL
2.a). No CHD but > 2 risk factors
- Goal <130 mg/dL
- Initiate Lifestyle Changes 130 mg/dL (All pts regardless of LDL)
- Drug130 mg/dL
2.b). No CHD but 2 risk factors
- Goal <130 mg/dL
- Lifestyle changes 130 mg/dL
- Drug 160 mg/dL
3). No CHD and 0-1 risk factors
- Goal <160 mg/dL
- Lifestyle changes 160 mg/dL
- Drug 190 mg/dL
* CHD risk equivalents include DM, PVD, CAD, AAA
Circulation 2004;110:227–239.
So both need better  lifestyfe + drug
-t.
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| DrAlex_76
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so how about 60 yo man with HTN and Diabetes type II.
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| nightflight1945
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kpmle2 wrote:
LDL goal for 2 or more risk factors is <130.
Yep , the goal is 130 , typing error.
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| kpmle2
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Risk Stratification and Target LDL
RISK CATEGORY TARGET LDL (MG/DL)
0–1 risk factor < 160
≥ 2 risk factors < 130
CAD or risk equivalent < 70
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| ngaybinhyen
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DrAlex, I thought it is classified into No.1 according to my source and yours. Goal 100, Lifestyle 130, Drug 130 (optional b/w 100-129).
70 mg/dL does not sound familiar to me. Can you post the source, kpmle2? This may be the updated one
Thanks
-t.
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| kpmle2
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70 mg/dL does not sound familiar to me. Can you post the source, kpmle2? This may be the updated one
Thanks
-t.
[/quote]
First aid step 2ck. Cardiology page 44.
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| ngaybinhyen
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Thanks kpmle2
I look again up in Brounward's. Please take a look at this
"Patients with CAD or atherosclerosis of other vascular beds (carotids or peripheral vascular disease), adults with diabetes, and those patients with an estimated 10-year risk of developing CAD of greater than 20 percent fall into a high-risk category and merit aggressive treatment including medications along with lifestyle modifications, exercise, and diet to achieve a primary target of an LDL cholesterol level less than 2.6 mmol/liter (100 mg/dl)"
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| DrAlex_76
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guys, just focus on guidelines of whatever called " American ....Association " , others just for references !
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| ngaybinhyen
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An AHA 2006 update focusing on secondary prevention of CHD recommends a more aggressive approach of an LDL-C goal of < 100 mg/dL for all patients with CHD and other clinical forms of atherosclerotic disease, and notes that it is reasonable to treat to LDL-C < 70 mg/dL in these patients
"70" is considered as OPTIONAL THERAPY based on what's called CUTPOINT FOR LDL-C LOWERING THERAPY
Keep thin in mind. I hope they wouldn't put these 2 options in one Q
-t
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| nightflight1945
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ngaybinhyen wrote:
An AHA 2006 update focusing on secondary prevention of CHD recommends a more aggressive approach of an LDL-C goal of < 100 mg/dL for all patients with CHD and other clinical forms of atherosclerotic disease, and notes that it is reasonable to treat to LDL-C < 70 mg/dL in these patients
"70" is considered as OPTIONAL THERAPY based on what's called CUTPOINT FOR LDL-C LOWERING THERAPY
Keep thin in mind. I hope they wouldn't put these 2 options in one Q
-t
I checked it again , you are right ngaybinhyen.Thank u very much for your nice post.
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| ngaybinhyen
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| tompat
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did u all see kaplan internal medicine 2008-2009 notes?! it just mentions target LDL level in hyperlipedemic pt. with CAD is 100mg/dl and it is 70mg/dl in very high risk pt.
very high risk pt. includes pt. with established cardiovascular disease plus any of the following:-
1) multiple risk factors such as DM,HTN, smoking
2)metabolic syndrome associated risk factors( tryglycerides greater than 200mg/dl, HDL less than 40mg/dl)
3)pt with acute coronary syndromes.
and there is no mention of 130mg/dl ot 160mg/dl of LDL and when to start diet therapy and drug therapy.
i think they have simplified it and now are pressing for lifestyle/diet modification no matter what is the level of LDL.
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| nightflight1945
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Do you think Kaplan is the most valid referrence out there??
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| tompat
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yes i think so. its written by dr. conrad fischer and its latest one keeping in mind what are the current guidelines out there.
and ain't ngaybinhyen is saying the same in his last post to which u have agreed to? any ways,what do u refer for IM Mr. nightflight1945? please let me know
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