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(updated December 2007)
In September 2006, the Canadian Cardiovascular society published an updated position statement with recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease (CVD). In developing the revised guideline the working group established primary and secondary review panels and used a guidelines research and evaluation process to grade the evidence available for each recommendation.
No changes in the process to identify the individual patient’s 10-year risk of CVD were made. The following table summarizes the revised management recommendations.
Supplemental tests which may be of interest include measurement of apolipoprotein B (Apo B) . Risk of CVD is highest in patients with an Apo B > 1.20 g/L and triglyceride level > 1.50 mmol/L. Increased Apo B and triglyceride concentrations are often seen in patients with type 2 diabetes. Quantitation of Apo B may also be valuable in assessing adequacy of statin treatment performed when serum ALT and CK are measured to monitor potential side effects.
The table summarizes the optimal concentration of Apo B in patients who are at high risk, moderate or low risk. (Note: this table was revised December 2007)
|
Risk |
10 y CAD risk |
Recommendations |
Supplemental Test
Apolipoprotein B
Optimal plasma level |
|
High or
patients with
diabetes,
atherosclerotic disease,
renal failure |
>20% |
Treatment Targets
Primary LDL-C <2.0 mmol/L
Secondary TC/HDL-C <4 |
<0.85 g/L |
Moderate |
10%-19% |
Treat when:
LDL-C >3.5 mmol/L
or
TC/HDL-C >5 |
<1.05 g/L |
Low |
<10% |
Treat when:
LDL-C >5.0 mmol/L
or
TC/HDL-C >6 |
<1.2 g/L |
Please note treatment targets are stated for the high risk level based on LDL-C as the primary treatment target.
For the moderate and low risk levels values at which treatment should be initiated are stated based on either elevated LDL-C or TC/HDL-C. These are not treatment targets.
When treatment is indicated for moderate and low risk levels the objective is to lower the LDL-C by at least 40%, optimally LDL-C < 2.5 mmol/L for moderate risk individuals and <3.5 mmol/l for low risk individuals.
For detailed discussion of the guideline, frequency of testing, other supplemental assays and treatment options please refer to reference listed below1.
Clinicians have indicated they do not wish to have the chart of target values printed on each of our reports. Click here to access a printable PDF form of the Framingham risk assessment tables used to assign risk category for individual patients based on age, sex, blood pressure, total cholesterol and HDL-cholesterol. This is also available on the OAML website at http://www.oaml.com/calculator/Lipids_Calculatorrev06012007.pdf.
References:
1. McPherson R. et.al. Canadian Cardiovascular Society position statement – Recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease. Can. J. Cardio 2006: 22(11) 913-927.
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