AAE Summary
One Published Clinical Guideline The AACE guidelines are useful for a prescribing practitioner because of the detail and up to date research literature provided (AACE, 2012). For both males and females, lab goals for LDL is less than 100 mg/dL, and patients with at least one high risk comorbidity, the goal is less than 70 mg/dL (AACE, 2012). Minimal adult goal for HDL lab value is 40mg/dL, but the goal is to make these levels rise (AACE, 2012). Also, the goal for both adult men and women for triglycerides is less than 150 mg/dL (AACE, 2012). The AACE suggests that addressing risk factors like diabetes, hypertension, obesity, and smoking will help control hyperlipidemia and reduce atherosclerosis (AACE, 2012). “The first-line approach to primary
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prevention in patients with lipid disorders involves the implementation of lifestyle changes, including physical activity and medical nutrition therapy. Treatment may also involve pharmacotherapy, as well as patient education programs, to promote further risk reduction through smoking cessation and weight loss” (AACE, 2012). If LDL is elevated, it is appropriate to start first-line drug choice of a statin drug regimen to lower lipid levels (AACE, 2012). The AACE list all statin drug choices and provides a list of the starting dosages (AACE, 2012). Simvastatin can be started at 20 to 40 mg (AACE, 2012). Other recommendations are listed such as combination therapies, and considerations for age and coexisting disease states (AACE, 2012).
Approach to the Treatment and Various Possibilities Treatment options may vary due to each patient’s tolerance and individuality of symptoms and lab results.
First-line treatment for patients at risk for CAD will focus on primary prevention by lifestyle modifications (AACE, 2012). This approach will consist of a comprehensive method involving physical activity (AACE, 2012). Activity plans will be formulated with patient goals outlined like 30 minutes of moderately intense physical activity at least four to six days a week (AACE, 2012). Next, nutritional plans will be formulated into the treatment of hyperlipidemia prevention to include ways to eliminate ingestion of saturated and trans fats (AACE, 2012). Vegetables, fruits, grains, fish, and lean meats are incorporated into the diet plan to reduce caloric intake and weight reduction (AACE, 2012). Since smoking aids in plaque build-up on the coronary arteries, smoking cessation is very important to incorporate into the care plan (AACE, 2012). Once smoking has stopped evaluation in 30 days will often show increased HDL levels (AACE, 2012). Once lab results show the diagnosis of hyperlipidemia, a medication regimen along with the mentioned primary prevention methods will be initiated to reduce cardiovascular events (AACE, 2012). The AACE reports statins are the number one drug choice (AACE, 2012). The approach to lowering severe high levels of triglycerides, fibrates is the treatment option that is appropriate (AACE, 2012). Other potential options if the primary choice is not appropriate is niacins, bile acid sequestriants, and cholesterol absorption inhibitors (AACE, 2012). Niacins are used to lower triglycerides and LDLs and elevating HDLs (AACE, 2012). Giving in conjunction with Omega 3 Fish Oil is appropriate if necessary for lower triglyceride levels (AACE, 2012). Reducing LDL but only modestly increasing HDLs is the bile sequestriants action in the body, but increased triglycerides and lowering glucose have been noted therefore not the first-line treatment
option (AACE, 2012). Cholesterol absorption inhibitors are used as a combination therapy with statins to reduce LDL levels (AACE, 2012).
Dietary supplements have been a popular approach to treating mild to moderate high cholesterol levels. Patients often have more compliance with a natural supplement and do not have as many hesitations when taking supplements compared to prescribed medication. The clinical trial of participants age 21 to 80 years old that had previously stopped at least one statin due to adverse effects were evaluated (Becker, Gordon, Halbert, French, Morris, & Rader, 2009). Treatment included three red yeast rice 600 mg capsules twice a day compared to three placebo capsules twice a day for 24 weeks (Becker et al., 2009). The group taking red yeast rice significantly showed lowering LDL levels compared to the placebo group (Becker et al., 2009). It was shown in this study that this may be an appropriate alternative therapy to the stain intolerant patient for lowering LDL levels (Becker et al., 2009).
prevention in patients with lipid disorders involves the implementation of lifestyle changes, including physical activity and medical nutrition therapy. Treatment may also involve pharmacotherapy, as well as patient education programs, to promote further risk reduction through smoking cessation and weight loss” (AACE, 2012). If LDL is elevated, it is appropriate to start first-line drug choice of a statin drug regimen to lower lipid levels (AACE, 2012). The AACE list all statin drug choices and provides a list of the starting dosages (AACE, 2012). Simvastatin can be started at 20 to 40 mg (AACE, 2012). Other recommendations are listed such as combination therapies, and considerations for age and coexisting disease states (AACE, 2012).
Approach to the Treatment and Various Possibilities Treatment options may vary due to each patient’s tolerance and individuality of symptoms and lab results.
First-line treatment for patients at risk for CAD will focus on primary prevention by lifestyle modifications (AACE, 2012). This approach will consist of a comprehensive method involving physical activity (AACE, 2012). Activity plans will be formulated with patient goals outlined like 30 minutes of moderately intense physical activity at least four to six days a week (AACE, 2012). Next, nutritional plans will be formulated into the treatment of hyperlipidemia prevention to include ways to eliminate ingestion of saturated and trans fats (AACE, 2012). Vegetables, fruits, grains, fish, and lean meats are incorporated into the diet plan to reduce caloric intake and weight reduction (AACE, 2012). Since smoking aids in plaque build-up on the coronary arteries, smoking cessation is very important to incorporate into the care plan (AACE, 2012). Once smoking has stopped evaluation in 30 days will often show increased HDL levels (AACE, 2012). Once lab results show the diagnosis of hyperlipidemia, a medication regimen along with the mentioned primary prevention methods will be initiated to reduce cardiovascular events (AACE, 2012). The AACE reports statins are the number one drug choice (AACE, 2012). The approach to lowering severe high levels of triglycerides, fibrates is the treatment option that is appropriate (AACE, 2012). Other potential options if the primary choice is not appropriate is niacins, bile acid sequestriants, and cholesterol absorption inhibitors (AACE, 2012). Niacins are used to lower triglycerides and LDLs and elevating HDLs (AACE, 2012). Giving in conjunction with Omega 3 Fish Oil is appropriate if necessary for lower triglyceride levels (AACE, 2012). Reducing LDL but only modestly increasing HDLs is the bile sequestriants action in the body, but increased triglycerides and lowering glucose have been noted therefore not the first-line treatment
option (AACE, 2012). Cholesterol absorption inhibitors are used as a combination therapy with statins to reduce LDL levels (AACE, 2012).
Dietary supplements have been a popular approach to treating mild to moderate high cholesterol levels. Patients often have more compliance with a natural supplement and do not have as many hesitations when taking supplements compared to prescribed medication. The clinical trial of participants age 21 to 80 years old that had previously stopped at least one statin due to adverse effects were evaluated (Becker, Gordon, Halbert, French, Morris, & Rader, 2009). Treatment included three red yeast rice 600 mg capsules twice a day compared to three placebo capsules twice a day for 24 weeks (Becker et al., 2009). The group taking red yeast rice significantly showed lowering LDL levels compared to the placebo group (Becker et al., 2009). It was shown in this study that this may be an appropriate alternative therapy to the stain intolerant patient for lowering LDL levels (Becker et al., 2009).