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2+ Risk factors e
(10-year risk 20%) c <130 130
10-year risk 10-20%: 130 c
10-year risk < 10%: 160 c 0-1 Risk factor f <160 160
190 (160-189: LDL-lowering drug optional)
a Therapeutic lifestyle changes include: 1) dietary changes: reduced intake of saturated fats (< 7% of total calories) and cholesterol (< 200 mg per day), and enhancing LDL lowering with plant stanols/ sterols (2 g/ d) and increased viscous (soluble) fiber (10-25 g/ d), 2) weight reduction, and 3) increased physical activity.
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b CHD risk equivalents comprise: diabetes, multiple risk factors that confer a 10-year risk for CHD >20%, and other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm and symptomatic carotid artery disease). c Risk assessment for determining the 10-year risk for developing CHD is carried out using the Framingham risk scoring. Refer to JAMA, May 16, 2001; 285 (19): 2486-2497, or the NCEP website (http:// www. nhlbi. nih. gov) for more details. d Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/ dL cannot be achieved by
therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e. g., nicotinic acid or fibrate.
Clinical judgment also may call for deferring drug therapy in this subcategory. e Major risk factors (exclusive of LDL cholesterol) that modify LDL goals include cigarette smoking, hypertension (BP 140/ 90 mm Hg or on anti-hypertensive medication), low HDL cholesterol (< 40 mg/ dL), family history of premature CHD (CHD in male first-degree relative <55 years; CHD in female first-degree relative <65 years), age (men 45 years; women 55 years). HDL cholesterol 60 mg/ dL counts as a "negative" risk factor; its presence removes one risk factor from the total count. f Almost all people with 0-1 risk factor have a 10-year risk <10%; thus, 10-year risk assessment in people with 0-1 risk factor is not necessary.
Prior to initiating therapy with ZETIA, secondary causes for dyslipidemia (i. e., diabetes, hypothyroidism, obstructive liver disease, chronic renal failure, and drugs that increase LDL-C and decrease HDL-C [progestins, anabolic steroids, and corticosteroids]), should be excluded or, if appropriate, treated. A lipid profile should be performed to measure total-C, LDL-C, HDL-C and TG. For TG levels >400 mg/ dL (> 4.5 mmol/ L), LDL-C concentrations should be determined by ultracentrifugation. At the time of hospitalization for an acute coronary event, lipid measures should be taken on admission or within 24 hours. These values can guide the physician on initiation of LDL-lowering therapy before or at discharge.
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