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Lipid Management for primary prevention of
ASCVDStan Schwartz, MD
Well, OK
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Relevant Disclosure and ResolutionUnder Accreditation Council for Continuing Medical Education
guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months.
Stan Schwartz, MD
I have no relevant financial relationships or affiliations with commercial interests to disclose.
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Experimental or Off-Label Drug/Therapy/Device Disclosure
I will NOT be discussing experimental or off-label drugs, therapies and/or devices that have not been approved by the FDA.
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Learning Objectives
Upon completion of this session, participants will improve their competence and performance by being able to:
1. Identify the differences between the USPSTF guidelines and the Academic Detailing Aid
2. Change the detailing approach to helping practices understand the USPSTF guidelines.
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Lipid guidelines one generation ago
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Decide whether primary or secondary prevention• ASCVD
• History of myocardial infarction• Acute coronary syndromes• Stable or unstable angina• Coronary or other arterial revascularization• Stroke• TIA• Peripheral arterial disease
Presumed to be of atherosclerotic origin
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Intensity of treatment
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Determine risk
55 year old manSBP 138SmokerWhiteChol-HDL 40 mg/dlChol-Total 250TG 180(LDL-calculated) 174
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United States Prev Services Task Force 2016
10 year risk 10% or greater
Low to moderate dose statinGrade B
10 year risk 7.5 - 10%
Low to moderate dose statinGrade C
● Age 40-74 (75+ = Grade I)● No ASCVD● 1or more risk factors
○ HTN, dyslipidemia, diabetes, smoking(dyslipidemia = LDL-C > 130 mg/dl or HDL < 40 mg/dl)
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10% risk is a lot of people
Age 60-69:
40% of men without ASCVD27% of women without ASCVDWill have 10 year risk of 10% or greater
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USPSTF vs our guidelines: treat or not treat?
72 year old manno smokingHDL-C 55Total-C 180SBP 118No diabetes10 yr risk = 15%
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Other clinical factors?
• Family history of premature ASCVD • < 55 years in 1st degree male relative or < 65 years in 1st degree female
relative) • High-sensitivity C-reactive protein ≥ 2 mg/L • Coronary artery calcium score ≥ 300 Agatston units 7 • Ankle brachial index < 0.9 • Elevated lifetime risk of ASCVD
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References