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Old 05-16-2011
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Question Which drug to start for this Lipid profile!

I'm struggling to absorb the facts on when to start- statin/ bile acid sequestrant/niacin therapy. Any one can help?

Confusing! What do we do if LDL level?

1) less than 160
2) over 130
3) between 160-190 etc.

And also need to consider risk factors!

Thanks in advance!
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Old 05-16-2011
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Post hope this helps

Well I am assuming we have already tried lifestyle modification and these are the values post lifestyle modification:
You ALWAYS start with statin if LDL is elevated, unless contraindicated.
Once you begin therapy, you evaluate after 3 months and if not at your goal then you add a second drug.
The choice for the second, you can look at the value for HDL, Triglycerides and also based on contraindications/indications choose a second therapy to add.
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Old 05-18-2011
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Hi 1TA2B,

Here are the guidelines for when to do lifestyle mod and when to start meds that I gleaned from combined Kaplan and UW questions. Let me know if it's not clear.

First, put the patient in one of the three following groups:
1. CAD or CAD risk equivalent
2. 2+ RF
3. 1-2 RF

CAD risk equivalents: DM, CAP, PAD, AAA, or 10 year risk >20%
Risk Factors (RF): M>45, W>55, htn, cigs, HDL <40, (HDL >60 is -1 RF)

Then depending on whether the pt is in groups 1, 2, or 3, apply the following limits:

LDL limits for lifestyle modification
1. >100
2. >130
3. >160

LDL limits for med management (niacin or simvastatin)
1. >100
2. >160
3. >190
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Old 05-18-2011
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Quote:
Originally Posted by healer2b View Post
Hi 1TA2B,

Here are the guidelines for when to do lifestyle mod and when to start meds that I gleaned from combined Kaplan and UW questions. Let me know if it's not clear.

First, put the patient in one of the three following groups:
1. CAD or CAD risk equivalent
2. 2+ RF
3. 1-2 RF

CAD risk equivalents: DM, CAP, PAD, AAA, or 10 year risk >20%
Risk Factors (RF): M>45, W>55, htn, cigs, HDL <40, (HDL >60 is -1 RF)

Then depending on whether the pt is in groups 1, 2, or 3, apply the following limits:

LDL limits for lifestyle modification
1. >100
2. >130
3. >160

LDL limits for med management (niacin or simvastatin)
1. >100
2. >160
3. >190

That's really helpful healer2b!

Thanks a million!
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