What's New? Guidelines and Goals

Several expert panels have written guidelines regarding the treatment of dyslipidemias. The recommendations from the National Cholesterol Education Program (NCEP); American Diabetes Association (ADA); American Heart Association (AHA); National Heart, Blood, and Lung Institute (NHBLI); and National Kidney Foundation (NKF) will be reviewed. The guidelines agree on several points: using the fasting lipid panel as the initial screening tool, targeting low-density lipoprotein cholesterol (LDL-C) initially, and achieving lower LDL-C goals. Some guidelines are more aggressive than those of the NCEP: the ADA and AHA have defined low high-density lipoprotein cholesterol as <50 mg/dL for women; the ADA recommends a need for drug therapy when the patient's total cholesterol, rather than LDL-C, is ≥135 mg/dL for patients who are older than 40 years; the NKF and the AHA have classified patients with chronic kidney disease in the high-risk category; and the AHA has revised the diagnostic criteria for metabolic syndrome to include additional people. More patients are qualifying for lifestyle modifications and medication treatment. A subset of these patients may require combination cholesterol-lowering medications to reach the new goals. Pharmacists will need to keep current with the literature and be knowledgeable about the guidelines to maximize the care given to our patients.