Brief Overview of hyperlipidemia in primary care

Terminology 

Dyslipidemia: increased risk of cardiovascular disease, medications may be useful

Hyperlipidemia: elevated total cholesterol, LDL cholesterol, or triglycerides

When to start screening (the answer will depend on what resource you are reading)

• For high-risk patients, I typically start screening around age 20-30. 
• For low-risk patients, I usually wait until age 35-40
• Men are higher risk so screening can begin earlier than for women. 

When to start a statin

1. H/o stroke or coronary heart disease 
2. LDL >190 
3. All diabetic patients starting age 40 with LDL 70-189
4. LDL 70-189 plus ASCVD risk >7.5

Note- ASCVD risk calculation is risk of cardiovascular event (stroke or heart attack) in next 10 years. Most EMR systems automatically calculate but there is a good app ASCVD Plus that you can plug in patient info (age, gender, race, BP, lipid numbers, history, etc.) and it will calculate for you. 

Choice of medication

• My go to is atorvastatin 10-20mg. F/u 2 months to recheck labs, then increase/adjust therapy as needed. 
• If they complain of muscle cramps or side effects they can switch to rosuvastatin 5-10mg. 
• If not able to tolerate statins, can try ezetimibe 10 mg daily.

PERLS  

Medicare typically will not cover lipid panel as a screening. If they have the dx of hyperlipidemia, that will usually work. Can try diagnosis of physical OR screening lipid Z13.220. 

Acknowledgments 

Pignone, M., Cannon, C. (2024). Low-density lipoprotein cholesterol-lowering therapy in the primary prevention of cardiovascular disease. http://uptodate.com/ contents/low-density-lipoprotein-cholesterol-lowering-therapy-in-the-primary-prevention-of-cardihttps://www.uptodate.com/contents/low-density-lipoprotein-cholesterol-lowering-therapy-in-the-primary-prevention-of-cardiovascular-disease?search=hyperlipidemia&source=search_result &selectedTitle=1%7E150&usage_type=default&display_rank=1#H937406940ovascular-disease?search=hyperlipidemia&source=search_result&selectedTitle=1 %7E150&usage_type=default&display_rank=1#H937406940