Shared decision-making in treating hyperlipidemia
Cholesterol management has evolved to become increasingly complex and individualized. Newer guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) detail risk assessment, novel non-statin treatment options, concerns centered on patient subgroups, and the value of therapy.
Treatment plans are now highly personalized, and experts recommend shared decision-making to fulfill patient needs. When discussing cholesterol management with patients, 4 tenets to keep in mind include the following:
- stress the importance of a heart-healthy lifestyle spanning the patient’s life;
- discuss the 10-year risk of atherosclerotic cardiovascular disease per the Pooled Cohort Equations, as well as mitigating risk factors;
- explain that although statins are the foundation of treatment, add-on options are available for patients on maximally tolerated statins who need to further lower their LDL-C levels;
- address special treatment algorithms in at-risk patient subgroups.
What has worked for you when advising patients on lipid-lowering therapy? What role does shared decision-making play when caring for your patients with hyperlipidemia?
Reynolds Risk Score
Source : https://www.reynoldsriskscore.org/
If you are healthy and without diabetes, the Reynolds Risk Score is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years.
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This is a good tool to demonstrate the risk in mathematical/percentage format. Lipids is one of several factors included in this calculation. Of course, lipid lowering medications are one option, but I do like to start with recommending diet modification and exercise to see if that helps. I have a lower threshold of recommending medications for those with other risk factors such as diabetes, family history of ASCVD, personal history of ASCVD, tobacco use, etc. Shared decision making plays a significant role when making decisions regarding hyperlipidemia since patients have different preferences with regard to treatment modalities (lifestyle modification vs. OTC medication vs. prescription medications. One of the significant factors to consider is side effects from medications.
ASCVD Risk Estimator +
Source : https://tools.acc.org/ascvd-risk-estimator-plus/
This calculator only provides 10-year risk estimates for individuals 40-79 years of age. to view brief suggestions for younger patients. Current 10-Year ASCVD Risk** Previous 10-Year ASCVD Risk Lifetime ASCVD Risk: Lifetime Risk Calculator only provides lifetime risk estimates for individuals 20 to 59 years of age.
Statin therapy is usually started at a dose likely not thought to reach goal but this mitigates side effects and when labs repeated in two months some progress can be a motivator and may allow the patient to accept a larger more therapeutic dose more easily.