Lipid Management in Patients with Endocrine Disorders
Key Points
Key Points
- Obtain a lipid panel in adults with endocrine disorders to assess triglyceride (TG) levels and to calculate LDL cholesterol (LDL-C).
- Treat adults with type 2 diabetes (T2D) and other cardiovascular (CV) risk factors with a statin in addition to lifestyle modifications, aiming for an LDL-C goal of <70 mg/dL.
- Consider statin therapy, irrespective of the CV risk score, in adults with type 1 diabetes who are age 40 years and older, or have a history of diabetes of at least 20 years, or either microvascular complications, chronic kidney disease (CKD) stages 1-4, or obesity.
- Rule out hypothyroidism in patients with hyperlipidemia before treatment with lipid lowering medications. In patients with hypothyroidism re-evaluate the lipid profile when the patient is euthyroid.
- Consider statin therapy as adjunct to lifestyle modifications in adults with persistent endogenous Cushing’s syndrome or adults taking chronic glucocorticoid therapy above replacement levels.
- For treatment of dyslipidemia in post-menopausal women, use statins, rather than hormone therapy, because statins reduce atherosclerotic cardiovascular disease (ASCVD).
- Evaluate and treat lipids and other CV risk factors in women who enter menopause early (before the age of 40-45 years).
Assessment
...sessment...
...eening and Cardiovascular Disease Risk...
...asurement of Lipids1.1 In adults with e...
...1. Lipids and Lipoproteins in Select E...
...sk Assessment
...adults with endocrine disorders, we recommend co...
....3 In adults with endocrine disorders at...
...tients with a family history of premature AS...
...ent of ASCVD Risk in Patients with E...
...gure 1. CVD Events per 1,000 Person-Years by...
...3. Proposed Decision-Making Approach...
Hypertriglyceridemia
...riglyceridemia...
...pertriglyceridemia...
...In adults with fasting TG levels over 500...
...tients with triglyceride-induced pancreatitis,...
...ents without diabetes who have TG-induced pancre...
...ts who are on statins and still have m...
...s with elevated TG (>150 mg/dL to 499 mg/dL [1.7...
Diabetes
Diabete...
...ype 2 Diabetes Mel...
...th T2D and other CV risk factors, we recommend...
...ults with T2D and other CV risk factors,...
...lts with T2D on a statin at LDL goal with resi...
...ith T2D with chronic kidney diseas...
...th T2D and diabetic retinopathy, we suggest f...
...e 1 Diabetes Mellit...
...n adults with type 1 diabetes (T1D)...
...with T1D with CKD in stages 1–4, we suggest sta...
...adults with T1D with obesity, or wi...
...n adults with T1D and diabetic retinopath...
Obesity
Obesit...
...Obesit...
...individuals who have obesity, we advise ass...
....2 In individuals who have obesity, we...
...n individuals who have obesity, we...
....4 In individuals who have obesity and are on pha...
...uals with obesity, (body mass index >40...
Other Conditions
...r Condition...
...hyroid Disease...
6.1 In patients with hyperlipidemia, we rec...
...ts with hyperthyroidism, we recommend r...
....3 In patients with overt hypothyr...
6.4 In patients with subclinical hy...
...Excess Glucocortico...
...ipid-Lowering Therapy in Cushing Syndrome
...adults with persistent endogenous Cus...
...lts with cured Cushing syndrome, we advis...
...d Management in Chronic Glucocorticoid...
....4 In adults receiving chronic glucocor...
...rders Of Growth Hormone Secretion...
...ult Growth Hormone Deficie...
...In adults with GHD, we recommend obtaining a li...
...dults with GHD associated with hypopituit...
....3 In adult patients with GHD, we recomme...
...mone Excess (Acromegaly)...
...lts with acromegaly, we suggest measurement of the...
...cystic Ovary Syndrome...
...d Abnormaliti...
...th polycystic ovary syndrome (PCOS), we re...
...iovascular Risk
...ment of PCOS on lipids9.2 In women with PCOS, w...
...Menopause And Hormonal Replacem...
...postmenopausal women, we recommend treati...
...0.2 In postmenopausal women on hormone th...
....3 In women who enter menopause ea...
...dism and Testosterone Replacement a...
...ents with low testosterone levels, we suggest t...
...1.2 In patients with low...
...Affirming Hormone Therapy
12.1 In transwomen and transmen who have...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
...le 4. Statins: LDL-C Reduction by Dose, and Majo...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...edications for Additional LDL-C Re...