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
...essment
1. Screening and Cardiovascular Disease Ris...
...asurement of Lipids1.1 In adults with...
...ids and Lipoproteins in Select Endocr...
...Risk Assessment...
...s with endocrine disorders, we recommend co...
...lts with endocrine disorders at borderline or...
1.4 In adult patients with a family history of pr...
...ssessment of ASCVD Risk in Patients...
...ents per 1,000 Person-Years by Strata of...
...Proposed Decision-Making Approach to S...
Hypertriglyceridemia
...ypertriglyceridem...
...pertriglyceridem...
...th fasting TG levels over 500 mg/dL (5....
...nts with triglyceride-induced pancreatitis, we...
....3 In patients without diabetes who have TG-induce...
...who are on statins and still have moderately...
...with elevated TG (>150 mg/dL to 499 mg/dL [1.7 mmo...
Diabetes
...abetes...
...Diabetes Mellitus...
...ults with T2D and other CV risk factors, we re...
....2 In adults with T2D and other CV risk facto...
...ith T2D on a statin at LDL goal with resi...
....4 In adults with T2D with chronic kidney disease...
...with T2D and diabetic retinopathy, we suggest...
...e 1 Diabetes Mellit...
...th type 1 diabetes (T1D) age 40 years and...
...ith T1D with CKD in stages 1–4, we suggest s...
...s with T1D with obesity, or with high TG and lo...
...th T1D and diabetic retinopathy, we suggest s...
Obesity
Obesi...
5. Obesit...
...individuals who have obesity, we advise assessm...
...2 In individuals who have obesity, we suggest...
...n individuals who have obesity, we re...
...uals who have obesity and are on pharmac...
...iduals with obesity, (body mass index >...
Other Conditions
Other Conditio...
.... Thyroid Disease...
...In patients with hyperlipidemia, w...
...with hyperthyroidism, we recommend re-evaluati...
...In patients with overt hypothyroidism, we sugg...
...ts with subclinical hypothyroidism (thyroid-stimul...
...Excess Glucocorticoids
...id-Lowering Therapy in Cushing Sy...
...dults with persistent endogenous Cushing syndr...
7.3 In adults with cured Cushing syndrome, w...
...Management in Chronic Glucocorticoid Therapy...
...adults receiving chronic glucocorticoid therapy...
...isorders Of Growth Hormone Secretion...
...th Hormone Deficiency...
...lts with GHD, we recommend obtaining a lipid pro...
...adults with GHD associated with hypopituitarism, w...
...3 In adult patients with GHD, we recommend agai...
Growth Hormone Excess (...
...s with acromegaly, we suggest measurem...
.... Polycystic Ovary S...
Lipid Abnormalit...
...with polycystic ovary syndrome (PCOS), we re...
...iovascular Risk...
...ct of treatment of PCOS on lipids9....
...e And Hormonal Replacement...
...postmenopausal women, we recommend treating...
...0.2 In postmenopausal women on hormone...
....3 In women who enter menopaus...
11. Hypogonadism and Testosterone Repla...
...atients with low testosterone levels, we sugg...
11.2 In patients with low HDL (
...Gender-Affirming Hormone Therapy...
...nswomen and transmen who have taken...
Table 4. Statins: LDL-C Reduction by Dose, and Major Drug Interactions
...: LDL-C Reduction by Dose, and Major Drug In...
Table 5. Medications for Additional LDL-C Reduction in Patients Taking Statins (maximal tolerated doses)
...tions for Additional LDL-C Reductio...