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Old 08-28-2011
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Heart Target LDL Level in Patients with Heart Disease

What is the target LDL goal for patients with heart disease, and what is the first line treatment for hyperlipidemia in these patients?
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Old 08-29-2011
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target is <70... 1st line rx... i m not sure.. either diet and exercise or a statin....
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Old 08-29-2011
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Quote:
Originally Posted by heights View Post
What is the target LDL goal for patients with heart disease, and what is the first line treatment for hyperlipidemia in these patients?
The target is 100 mg/dL. You treat with drugs when LDL is higher than this value. 70 mg/dL is the cut off when the patient has another pathology such as aneurysms, or history of MI.
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Old 08-29-2011
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http://www.mayoclinic.com/health/cho...levels/CL00001

Ideal for people at very high risk of heart disease Below 70 mg/dL

Ideal for people at risk of heart disease Below 100 mg/dL

Near ideal 100-129 mg/dL

Borderline high 130-159 mg/dL

High 160-189 mg/dL

Very high 190 mg/dL and above




LDL targets differ

Because LDL cholesterol is a major risk factor for heart disease, it's the main focus of cholesterol-lowering treatment. Your target LDL number can vary, depending on your underlying risk of heart disease.
Most people should aim for an LDL level below 130 mg/dL (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (1.8 mmol/L). In general, the lower your LDL cholesterol level is, the better.
You're considered to be at a high risk of heart disease if you have:
  • A previous heart attack or stroke
  • Artery blockages in your neck (carotid artery disease)
  • Artery blockages in your arms or legs (peripheral artery disease)
In addition, two or more of the following risk factors might also place you in the very high risk group:
  • Smoking
  • High blood pressure
  • Low HDL cholesterol
  • Diabetes
  • Family history of early heart disease
  • Age older than 45 if you're a man, or older than 55 if you're a woman
  • Elevated lipoprotein (a), another type of fat (lipid) in your blood

Last edited by MANIAKOS; 08-29-2011 at 07:50 AM.
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Old 08-29-2011
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well it´s 100 mg/dL
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Old 08-29-2011
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Default Ans: 70 by new guidelines, 100 old guidelines

If you said 70 or 100, you are right! The specific answer depends on the clinical scenario. If you have a patient with coronary artery disease, MI, stroke etc, you always put them on a statin the evidence is very strong that lowering LDL can prevent heart disease. The previous guidelines were that you should have a target of <100, but the new guidelines are that if the patient has heart disease or diabetes (i.e. high risk) achieving an even lower LDL can be beneficial so you should have a target of 70.
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Old 08-30-2011
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CAD or equivalent [DM]

LDL should be less than 70

start statins when u see LDL 100.

that solves q's :-)
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Old 08-30-2011
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Originally Posted by tyagee View Post
CAD or equivalent [DM]

LDL should be less than 70

start statins when u see LDL 100.

that solves q's :-)
Not quite right- start statins at anything above 70! See above explanations
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Quote:
Originally Posted by heights View Post
Not quite right- start statins at anything above 70! See above explanations
here is explnation which i found reasonable...

The correct answer is B. Patients with diabetes are considered to have a coronary heart disease equivalent. according to current
ATP Ill guidelines.The accepted low·density lipoprotein (LDL) cholesterol goalfor patients considered high·risk for coronary heart
disease (CHD), coronary heart disease, or coronary heart disease equivalent (such as diabetes or a stroke) is less than 100 mg/dl.
The 2004 revision of the ATP Ill guidelines states that for those patients presenting with baseline cholesterol level of 100 mg/dthl e
physician may further reduce the cholesterol levelto <70 mg/dinl
those with very high·riskfactors. This is an optional guideline and
not mandatory.Recent studies, including the PROVEIT· trial and the Heart Protection Study, indicate that lower levels may even be
better, although they are not currently recommended, and none had levels as low as 40 mg/d(lchoice A) .
Risk factors for coronary heart disease include:
• Males >45 and females >55 years of age
• Family history of premature CHD (sudden cardiac death in a first·degree relative, or myocardial infarction in a male relative <55
years old or female relative <65 years)
• Hypertension
• Smoking
• Low HDL cholesterol (<40 mg/dl)
An LDL cholesterol level of less than 130 mg/d(lchoice C) , according to current ATP Ill guidelines, is an appropriate goal for
patients with two or more cardiac risk factors (moderate risk).
An LDL cholesterol level of less than 160 mg/d(lchoice D) is accepted as a goal by current ATP Ill guidelines for patients with zero
to one cardiac risk factor (low risk).Note that many physicians will aim for lower LDL cholesterol levels. If this patient had only high
blood pressure and did not have diabetes,this levelwould be an accepted goal by current standards.
A level of 180 mg/d(lchoice E) is high regardless of a patient's preexisting risk (a level this high actually constitutes a risk factor by
itself),which is determined by the number of cardiac risk factors a patient has (such as smoking,family history of early coronary
heart disease, and hypertension).
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