Professional Documents
Culture Documents
Collaboration
First Case
Educational Support by
PT AstraZeneca Indonesia
Not a smoker
Fasting blood glucose and liver enzymes were within normal limits
Chest x-ray normal, ECG showed old anteroseptal wall MI
STEP 1
Estimation of patients
risk level by performing
risk assessment
Risk Categories
CHD
CHD risk equivalent
Major risk factor
of atherosclerotic
disease
Diabetes Mellitus
type II
Diabetes Mellitus
type I
Chronic kidney
disease
TIA/Stroke
High CVD
Low CVD
Risk Level
Very High risk
High risk
Low risk
< 70 mg/dL
< 100 mg/dL
< 130 mg/dL
< 160 mg/dL
STEP 2
Determine dyslipidemia
and the treatment target
Risk Category
LDL-C
Moderate Risk
High Risk
< 70 mg/dL
STEP 3
Determine
intervention strategies
Intervention Strategies
Depending on Total CV Risk and LDL-C Level
Total CV
Risk
(SCORE)
%
LDL C (mg/dL)
<70
70 <100
100 <155
155 <190
190
<1
No
intervention
No
intervention
LSI
LSI
LSI, drug if
uncontrolled
1 <5
LSI
LSI
LSI, drug if
uncontrolled
LSI, drug if
uncontrolled
LSI, drug if
uncontrolled
>5 <10,
or high risk
LSI,
consider
drug if MI
LSI,
consider
drug if MI
LSI + drug
therapy
LSI + drug
therapy
LSI + drug
therapy
10, or
very high
risk
LSI,
consider
drug if MI
LSI + drug
therapy
LSI + drug
therapy
LSI + drug
therapy
LSI + drug
therapy
Increase HDL-C
Lower TG
6 weeks
Visit 2
LDL goal not achieved
Intensify LSI
6 weeks
Visit 3
LDL goal achieved
Continue LSI
Visit 3
LDL goal not achieved
Drug therapy
MANAGEMENT
Define baseline LDL-C
145 mg/dL
< 70 mg/dL
Define % LDL-C
lowering
Minimum
51,72%
Atorvastatin (mg)
Simvastatin (mg)
Mean %
Change
in LDL-C
From
Untreated
Baseline
Pravastatin (mg)
LDL-C
(mg/dL)
(mg/dL)
300
(mg/dL)
65
350
250
200
HDL-C
204.8*
198.7*
(88)
(81)
218.2*
(79)
300
288.2*
281.4*
(90)
(90)
56.1
(80)
250
150
200
(83)
135.7
100
0
116.8
(75)
***
-34%
***
59.0
(81)
60
55
222.0
(81)
61.8
(83)
299.0*
(84)
-42% -47%
(90)
200.5
200.2
(80)
(81)
51.1*
50
115.1
(76)
55.0*
***
49.6*
150
***
***
( ) :Number of cases
week 0
*** : p<0.001 (vs. week 0) by one sample t-test
Subjects: Hypercholesterolemia (including FH)
Dosage: 1mg, 2mg or 4mg, once a day for 12 weeks
***
***
(90) ***
+7.3 mg/dL+5.9
mg/dL
(84)
***
+7.9
mg/dL
Dose, mg/d
LDL-C
reduction, %
80
5154
10/20
51
20
52
STEP 4
Secondary target achievement if
primary target has been achieved
in high risk or very high risk
patients with TG higher than 200
mg/dL
TG 200 mg/dL
TG 500 mg/dL
TLC
Immediate fibrate therapy
No
regardless of current
LDL-C level and CHD
risk
Consider fenofibrate
addition