Clinical Skills

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STATEMENT OF INTENT This guideline was developed to be a guide for best clinical practice in the management of dyslipidaemia. It is based on the best available evidence at the time of development. Adherence to this guideline does not necessarily lead to the best clinical outcome in individual patient care. Thus, every health care provider is responsible for the management of his/her unique patient based on the clinical presentation and management options available locally. REVIEW OF THE GUIDELINE This guideline was issued in 2011 and will be reviewed in 2016 or earlier if important new evidence becomes available. CPG Secretariat Health Technology Assessment Unit Medical Development Division Level 4, Block EI, Parcel E Government Offices Complex 62590 Putrajaya, Malaysia Available on the following websites: http://www.malaysianheart.org http://www.moh.gov.my http://www.acadmed.org.my

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SUMMARY • Total cholesterol (TC) and High Density Cholesterol (HDL-C) can be measured in the fasting and non fasting states. Triglycerides (TG) is best measured in a fasting sample. Low Density Cholesterol (LDL-C) is calculated using the Friedwald’s equation. When TG > 2.3mmol/l, non HDL-C is a better indicator of total atherogenic burden. • Dyslipidaemias may be primary or secondary. • Target of therapy: • LDL-C should be the primary target of therapy I,A • Non HDL-C should be an alternative primary target of therapy in patients with TG > 4.5 mmol/l I,A • Individuals should be risk stratified. I,C (See Table 1, pg 3 and Fig 1A & B, 2A & B, pg 30-31) • Diabetes is a Coronary Heart Disease (CHD) risk equivalent. I,A • Target lipids levels will depend upon the individual’s global risk. – CVD and CHD risk equivalents LDL-C < 2.6 mmol/L with (High Risk): an option of 1.6 mmol/L Table 2 : Recommendations for Drug Therapy for Dyslipidaemia

Medications Grades of recommendation/ Levels of evidence I, A Comments

Statins

Ezetimibe

IIa, B IIa, C

Reduction of...