Dr Subhasish Deb

Burdwan Medical College and Hospital

Department of General Medicine

2013 ACC/AHA BLOOD

CHOLESTEROL

GUIDELINES

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

No LDL targets

Only STATINS to be used

Identification of 4 groups to benefit from

statin

-only considers high quality RCT data

THE CRUX

Dr Subhasish Deb, BMCH

LDL TARGETS

(NCEP ATP III)

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

1. Cigarette smoking

2. HTN (BP>=140/90 or on medication)

3. Low HDL-C (<40mg/dl)

4. Family history of premature CHD

a) CHD in male 1` relative <55yrs

b) CHD in female 1` relative <65yrs

5. Age : Men>=45yrs, Women >=55yrs

HDL>=60mg/dl counts as a negative risk factor. Its

presence removes 1 risk factor from total count

MAJOR RISK FACTORS IN NCEP ATP III

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

ACC/AHA

Statin benefit groups

Dr Subhasish Deb, BMCH

GROUP 1

Pts with clinical ASCVD(ACS, h/o MI, stable angina,

Stroke, PVD of atherosclerotic

Orign)

GROUP 2

GROUP 3 GROUP 4

LDL >=190 mg/dl

• LDL 70-189mg/dl

• Age 45-75yrs

• Diabetic

• LDL 70-189mg/dl

• Age 45-75yrs

• 10yr ASCVD

Risk >=7.5 %

High Intensity Statins High Intensity Statins

Moderate Intensity Statins Moderate Intensity Statins

EXCEPTION: Moderate Intensity if AGE >75yrs

EXCEPTION: High Intensity if

ASCVD>7.5% Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

NYHA II- IV ischemic systolic

Heart Failure

Pts. On maintenance

hemodialysis

WHEN NOT TO “STATINZE”

Dr Subhasish Deb, BMCH

SAFETY

RECOMMENDATIONS

FOR STATIN USE

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

Dr Subhasish Deb, BMCH

Mr. Mondal, 54yr old, smoker on Tab

amlodipine 10 o.d had hemiplegia on right side.

His lipid profile shows:

Cholesterol 268

Trig 168

Hdl 35

Ldl 142

CASE 1

HIGH INTENSITY STATINDr Subhasish Deb, BMCH

Mrs Rehima Bibi, 34yr old non smoker on

amlodipine 5 and tab prazosin 5, grade V ckd

on H/d.

Cholesterol 268

Trig 168

Hdl 35

Ldl 198

CASE 2

NO STATIN

Dr Subhasish Deb, BMCH

48yrs old Mr. JD, non smoker non htn, on

metformin 500 b.d lipid profile shows:

Cholesterol 238

Trig 198

Hdl 30

Ldl 158

CASE 3

MODRATE INTENSITY

Dr Subhasish Deb, BMCH

Mr Roy, 50yrs smoker, alcoholic, BP= 150/90

with:

Cholesterol 238

Trig 198

Hdl 30

Ldl 158

CASE 4

MODERATE INTENSITY STATINAscvd Risk = 32.1%

Dr Subhasish Deb, BMCH

Thank YouTHANK YOU

Dr Subhasish Deb, BMCH