Lipid Screening and Management in Adults

[2014 update]

Introduction to this self-study CME activity

Purpose

Studies demonstrate that lipid management is effective and cost-effective for secondary prevention and in some circumstances for primary prevention of coronary heart disease (CHD) and athlerosclerotic cardiovascular disease (ASCVD).  This self-study activity provides practical guidance for clinicians to understand and implement appropriate about screening and management of lipids, including detailed information regarding:

  • Screening guidelines
  • Assessing ASCVD risk
  • For those with no ASCVD or low risk for it, reinforce healthy lifestyle
  • For those with ASCVD or meaningful risk for it, treatment guidelines for lifestyle changes, statin therapy, and follow up.  (Note: chronic kidney disease is addressed separately in the UMHS clinical guideline on that topic.)

New information in this updated guideline includes:

  • Change in treatment strategy: moving from previous "treat to target" approach to now focusing on using appropriate intensity statin therapy based on ASCVD risk level
  • Dosing for LDL-C reduction: high-intensity statin (≥ 50% LDL-C reduction), moderate-intensity statin (30%-50% LDL-C reduction).   
  • Clinical ASCVD: age ≤ 75 yrs = high-intensity; age > 75 yrs = moderate-intensity
  • LDL-C ≥ 190 mg/dL, age ≥ 21 = high-intensity
  • Diabetes (type 1 or 2) and age 40-75 yrs with LDL-C 70-189 mg/dL = moderate-intensity; can consider high-intensity if 10-year ASCVD risk ≥ 7.5% (expert opinion)
  • 10-year ASCVD risk ≥ 7.5% and age 40-75 yrs with LDL-C 70-189 mg/dL, without DM, without clinical ASCVD = moderate-to-high intensity
  • Screening and monitoring:
  • Obtain a screening lipid profile, either fasting or, for patient convenience, non-fasting to facilitate obtaining data.   Abnormal non-fasting screening lipids can go on to have a fasting lipid panel.
  • Monitor with annual lipid profile in order to assess for adherence (rather than to adjust statin dose).

 Key aspects of care include:

  • Lipid management is effective and cost-effective for secondary prevention and in some circumstances for primary prevention.
  • Lifestyle modification is a critical component of health promotion and ASCVD risk reduction in both primary and secondary prevention
  • Secondary prevention reduces mortality and CHD/atherosclerotic cardiovascular disease endpoints.  All secondary prevention patients should be considered for drug therapy
  • Primary prevention using lifestyle modifications and, if needed, drug therapy is targeted to patients' individual risk levels

Objectives

Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for lipid screening, identifying patients who would benefit from treatment, and recommending appropriate treatment regimens in adults 20-79 years of age.

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers who screen and manage lipids in adults.

Authors

Team Leaders

  • Audrey L. Fan, MD
    General Medicine

Team Members

  • Jill N. Fenske, MD
    Family Medicine
  • R. Van Harrison, PhD
    Medical Education
  • Elizabeth A. Jackson, MD
    Cardiology
  • Marie A. Marcelino, PharmD
    Pharmacy Services

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.
Audrey L. Fan, MD
(None)
Jill N. Fenske, MD
(None)
R. Van Harrison, PhD
(None)
Elizabeth A. Jackson, MD
Consultant
Pfizer
Marie A. Marcelino, PharmD
(None)

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant Greenberg, MD, MA, MHSA
  • R. Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in May 2014 with credit available through April 2017. The activity was reviewed for currency of content in September 2017 and availability of credit extended through August 2020. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.