When to start lipid lowering medications in CAD

[Bagheera]

There seems to be some confusion from differnet sources regarding when to start cholestrol meds. UWORLD says start meds for CAD or CAD equivalent if LDL is >130 from what I remember. Other places I am seeing are saying start them if its above 100. What is the correct answer regarding this ? thanks1

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[kaleerkalut]

There seems to be some confusion from differnet sources regarding when to start cholestrol meds. UWORLD says start meds for CAD or CAD equivalent if LDL is >130 from what I remember. Other places I am seeing are saying start them if its above 100. What is the correct answer regarding this ? thanks1

I have this question as well. Thanks in advance.

 

[StrangerX]

There seems to be some confusion from differnet sources regarding when to start cholestrol meds. UWORLD says start meds for CAD or CAD equivalent if LDL is >130 from what I remember. Other places I am seeing are saying start them if its above 100. What is the correct answer regarding this ? thanks1

UWorld is also internally conflicting regarding this (different questions with different guidelines). Last time I had access to the complete suite of questions I sent them a message in the feedback icon of the respective questions. I don't know whether they took out the question or altered it. Of note is that Step Up uses the 130 cutoff, but my preceptor mentioned using 100 as a guideline for medications.

 

[Raryn]

Known CAD it's <100 with an optional goal of <70 in severely high risk patients.

 

[2014 match]

There seems to be some confusion from differnet sources regarding when to start cholestrol meds. UWORLD says start meds for CAD or CAD equivalent if LDL is >130 from what I remember. Other places I am seeing are saying start them if its above 100. What is the correct answer regarding this ? thanks1

I guess the goal is less then LDL < 100, with lifestyle modifications used as primary preventive measure between 100-130 in CAD equivalents, and medications as primary preventive measure in patients with LDL >130. But if lifestyle modification fails, then medications would be required. The ultimate goal is to have a LDL <100 in CAD/ CAD equivalents. Correct me if I am wrong.

 

[Bagheera]

I guess the goal is less then LDL < 100, with lifestyle modifications used as primary preventive measure between 100-130 in CAD equivalents, and medications as primary preventive measure in patients with LDL >130. But if lifestyle modification fails, then medications would be required. The ultimate goal is to have a LDL <100 in CAD/ CAD equivalents. Correct me if I am wrong.

thats exactly what I got from UWORLD but some other sources say to start meds if LDL>100 and doesnt even mention ne thing about lifestyle changes for 100-130, so if on the exam i see this type of question i dont know what to put

 

[2014 match]

thats exactly what I got from UWORLD but some other sources say to start meds if LDL>100 and doesnt even mention ne thing about lifestyle changes for 100-130, so if on the exam i see this type of question i dont know what to put

The table you're referring to from UWorld comes from the ATP III guidelines. It is the same table as given in the original guidelines.

Take a look at the update of the ATP III guidelines i.e. :

http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04.pdf
Refer to Pg 228, 1st column last paragraph.

I haven't found anything more current than these guidelines.

 

[Raryn]

thats exactly what I got from UWORLD but some other sources say to start meds if LDL>100 and doesnt even mention ne thing about lifestyle changes for 100-130, so if on the exam i see this type of question i dont know what to put

At least in real life, for someone with a CAD equivalent, you start them on meds+lifestyle interventions if their LDL is >100 (or, if you feel they're EXTREMELY high risk because of things like multiple previous MIs, LDL >70). Note, there's no "lifestyle only" option for these very high risk people.

For someone who has multiple risk factors but no CAD equivalent, you do drugs at LDL >130, lifestyle interventions (+/- drugs) at LDL 100-129. Most people just do statins either way.

For someone with 0-1 risk factors, you're OK with LDL being up to 160.

 

[evilbooyaa]

I'd probably go with Meds for CHD or equivalent if LDL > 130. If less than 130, suggest lifestyle changes (unless they already have or failed them).

 

[StrangerX]

At least in real life, for someone with a CAD equivalent, you start them on meds+lifestyle interventions if their LDL is >100 (or, if you feel they're EXTREMELY high risk because of things like multiple previous MIs, LDL >70). Note, there's no "lifestyle only" option for these very high risk people.

For someone who has multiple risk factors but no CAD equivalent, you do drugs at LDL >130, lifestyle interventions (+/- drugs) at LDL 100-129. Most people just do statins either way.

For someone with 0-1 risk factors, you're OK with LDL being up to 160.

This sounds right, I remember reading it somewhere during my medicine rotation but don't remember where. It made the most sense in trying to reconcile the information from various sources when I read it at the time.