Hypercholesterolemia: Difference between revisions
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==Treatment== | ==Treatment== | ||
[[Clinical practice guideline]]s by the [[National Institute for Health and Clinical Excellence]] recommend treatment if the estimated 10 year risk of cardiovascular disease is at least 20%.<ref name="pmid">{{cite journal |author=Cooper A, O'Flynn N |title=Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance |journal=BMJ |volume= |issue= |pages= |year=2008 |pmid=18511800 |pmc=2405875 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18511800 |issn=}}</ref><ref name="urlNICE guidance by type">{{cite web |url=http://www.nice.org.uk/guidance/index.jsp?action=byID |title=Lipid modification |author=Anonymous |authorlink= |coauthors= |date=2008 |format= |work= |publisher=National Institute for Health and Clinical Excellence |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=2008-08-26}}</ref> | [[Clinical practice guideline]]s by the [[National Institute for Health and Clinical Excellence]] recommend treatment if the estimated 10 year risk of cardiovascular disease is at least 20%.<ref name="pmid">{{cite journal |author=Cooper A, O'Flynn N |title=Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance |journal=BMJ |volume= |issue= |pages= |year=2008 |pmid=18511800 |pmc=2405875 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18511800 |issn=}}</ref><ref name="urlNICE guidance by type">{{cite web |url=http://www.nice.org.uk/guidance/index.jsp?action=byID |title=Lipid modification |author=Anonymous |authorlink= |coauthors= |date=2008 |format= |work= |publisher=National Institute for Health and Clinical Excellence |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=2008-08-26}}</ref> | ||
[[Ezetimibe]] is one drug that can reduce [[cholesterol]]. However, a recent [[randomized controlled trial]] found it did not reduce [[atherosclerosis]] in the [[carotid artery]].<ref name="pmid18376000">{{cite journal |author=Kastelein JJ, Akdim F, Stroes ES, ''et al'' |title=Simvastatin with or without ezetimibe in familial hypercholesterolemia |journal=N. Engl. J. Med. |volume=358 |issue=14 |pages=1431–43 |year=2008 |month=April |pmid=18376000 |doi=10.1056/NEJMoa0800742 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18376000&promo=ONFLNS19 |issn=}}</ref> | |||
===Primary prevention=== | ===Primary prevention=== | ||
Revision as of 06:48, 17 September 2008
Hypercolesterolemia is "a condition with abnormally high levels of cholesterol in the blood. It is defined as a cholesterol value exceeding the 95th percentile for the population."[1]
Treatment
Clinical practice guidelines by the National Institute for Health and Clinical Excellence recommend treatment if the estimated 10 year risk of cardiovascular disease is at least 20%.[2][3]
Ezetimibe is one drug that can reduce cholesterol. However, a recent randomized controlled trial found it did not reduce atherosclerosis in the carotid artery.[4]
Primary prevention
Overall mortality is insignificantly reduced from 6.6% over 4.3 years to 6.1% in patients without prior cardiovascular disease (Number needed to treat, although statistically insignificant, is estimated to be 200).[5]
Secondary prevention
Clinical practice guidelines by the National Institute for Health and Clinical Excellence recommend treatment goal of <4 mmol/l (77 mg/dl)or a low density lipoprotein cholesterol concentration of <2 mmol/l (154 mg/dl).[2][3]
Diabetic patients
Statin therapy prevents major vascular events in about 1 of every 24 patients with diabetes who use the treatment for 5 years if they are similar to the patients in the meta-analysis by Kearney et al (Number needed to treat is 24).[6]
Treating to a goal of LDL-C < 70 mg/dl and systolic blood pressure to < 115 mm Hg may cause regression of carotid intial media thickness in a randomized controlled trial.[7]
References
- ↑ Anonymous. Hypercholesterolemia. National Library of Medicine. Retrieved on 2008-01-18.
- ↑ 2.0 2.1 Cooper A, O'Flynn N (2008). "Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance". BMJ. PMID 18511800. PMC 2405875. [e]
- ↑ 3.0 3.1 Anonymous (2008). Lipid modification. National Institute for Health and Clinical Excellence. Retrieved on 2008-08-26.
- ↑ Kastelein JJ, Akdim F, Stroes ES, et al (April 2008). "Simvastatin with or without ezetimibe in familial hypercholesterolemia". N. Engl. J. Med. 358 (14): 1431–43. DOI:10.1056/NEJMoa0800742. PMID 18376000. Research Blogging.
- ↑ Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK (2006). "Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials". Arch. Intern. Med. 166 (21): 2307–13. DOI:10.1001/archinte.166.21.2307. PMID 17130382. Research Blogging.
- ↑ Kearney PM, Blackwell L, Collins R, et al (2008). "Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis". Lancet 371 (9607): 117–25. DOI:10.1016/S0140-6736(08)60104-X. PMID 18191683. Research Blogging.
- ↑ Howard, B. V., Roman, M. J., Devereux, R. B., Fleg, J. L., Galloway, J. M., Henderson, J. A., et al. (2008). Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized Trial. JAMA, 299(14), 1678-1689. DOI:10.1001/jama.299.14.1678.