Continuing Medical Education (CME)

Lipid Screening and Management in Adults

Introduction to this self-study CME activity

Purpose

Studies demonstrate that lipid management is effective and cost-effective for secondary prevention and in some circumstances for primary prevention of coronary heart disease (CHD) and athlerosclerotic cardiovascular disease (ASCVD). This self-study activity provides practical guidance to clinicians about screening and managing lipids, including detailed information regarding:

• Screening guidelines
• Primary prevention: targeting patients’ individual risk levels for primary prevention using lifestyle modifications and drug therapy if needed.
• Secondary prevention: all secondary prevention patients should be considered for drug therapy, which reduces mortality and CHD/ASCVD endpoints
• Selecting cost effective agents

New to the 2009 revision:

• Secondary prevention trials in acute coronary syndrome (ACS) and stable coronary heart disease (CHD) confirm that high intensity statin therapy reduces events more than low intensity statin therapy
• All secondary prevention patients should be considered for statin therapy, regardless of LDL-C, targeting at least a moderate potency statin (simvastatin 40mg/day) even in patients with healthy lipids
• For high risk, target LDL-C ≤ 100 mg/dl.  High risk is CHDwithout major risk factors or other risks associated with “very high” risk.
• For very high risk, target LDL-C substantially < 100 mg/dl (option ≤ 70mg/dl).  Very high risk is CHDor other atherosclerotic vascular disease plus one or more of: major risk factors (e.g. diabetes, metabolic syndrome, active cigarette smoking), or acute coronary syndrome.
• Simvastatin is now generic
• For primary prevention screen: men age 35 and older and age 20 to 35 if at increased risk for CHD; women age 20 and older if at increased risk for CHD
• Avoid combination statin/gemfibrozil due to increased myopathy risk
• Management of statin intolerant patients is discussed (table 8)

Key aspects of care include:

• Treat all secondary prevention patients with lifestyle modification
• Secondary prevention reduces mortality and CHD/atherosclerotic cardiovascular disease endpoints
• All secondary prevention patients should be considered for drug therapy
• Primary prevention using lifestyle modifications and drug therapy if needed is targeted to patients' individual risk levels

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers screening and managing lipids in adults.

Authors

Team Leader
	William E. Barrie, MD General Medicine
Team Members
	R. Van Harrison, PhD Medical Education Ujjaini B. Khanderia, PharmD Pharmacy Services Robert B. Kiningham, MD Family Medicine Robert S. Rosenson, MD Cardiology
Author Disclosures
	Team Member Company Relationship William Barrie, MD (none)   Van Harrison, PhD (none)   Ujjaini Khanderia, PharmD Pfizer Speakers Bureau, Research Support Robert Kiningham, MD (none)   Melvyn Rubenfire, MD Abbott Consultant,  Speaker’s Bureau, Research Support   Astra Zenica Consultant,  Speaker’s Bureau, Research Support   Anthera Research Support   Liposcience Consultant, Shareholder   Roche Consultant   Sanofi Aventis Consultant

Other Acknowledgements

UMHS Guidelines Oversight Team: William E. Chavey, MD R. Van Harrison, PhD Connie J. Standiford, MD Literature search services: Taubman Medical Library Production of Internet format and web site maintenance: Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in September 2009. CME credit may be awarded for a maximum of three years from its release date, specifically fromFebruary 2009 through January 2012. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

Method of Participation

1. View the web pages. You may print the self-study text to read off-line.
2. Complete the on-line learning assessment test.  It will be electronically scored and the correct answers returned immediately for your review.
3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
4. Print the certificate of participation for your personal records.

 

NEXT > Guideline