Dyslipidemia

Initial screening

• Fasting lipid profile (FLP) × 2*, average results

Severe abnormalities → refer immediately

• TG >= 500 mg/dL → Consult lipid specialist
• LDL-C >= 250 mg/dL → Consult lipid specialist

Targets (otherwise)

• LDL-C >=130, <250 mg/dL** → Target LDL-C
• TG >=100, <500 mg/dL, <10 y → Target TG
• TG >=130, <500 mg/dL, 10-19 y → Target TG

Initial management (6 months)

• Exclude secondary causes
• Evaluate for other risk factors (RFs)
• Start Cardiovascular Health Integrated Lifestyle Diet (CHILD 1) → CHILD 2-LDL + lifestyle change × 6 months***
• Then repeat FLP

FLP at target

• LDL-C <130 mg/dL → Continue CHILD 2-LDL → Repeat FLP q. 12 months

Persistent elevation — management by category

• LDL-C >=130 to 189 mg/dL, family history (FHx) (-), no other RFs → Continue CHILD 2-LDL, Follow q. 6 m with FLP, FHx/RF update
• LDL-C >=190 mg/dL → Initiate statin therapy
• LDL-C >=160 to 189 mg/dL, FHx (+) or 1 high-level RF or >=2 moderate-level RFs → Initiate statin therapy
• LDL-C >=130 to 159 mg/dL + 2 high-level RFs or 1 high-level + >=2 moderate-level RFs OR clinical CVD → Initiate statin therapy

Follow-up after statin therapy

• Follow with FLPs, related chemistries
• → LDL-C still >=130 mg/dL, TG <200 mg/dL, refer to lipid specialist for addition of second lipid-lowering agent
• → In high LDL-C patients, if non-HDL-C >=145 mg/dL after effective LDL-C treatment, → Target TG