Dyslipidemia Venous Thromboembolism Stroke Sample Paper

Dyslipidemia / Venous Thromboembolism / Stroke

The 2013 ACC/AHA Blood Cholesterol Guidelines for ASCVD Prevention recommend high intensity artovastatin (40mg to 80mg) in diabetic patient (Stone et al., 2013). The patient should be on at least artovastatin 40mg but the dose should not go beyond 80mg to prevent ASVD. The determination of the right dosing is a result of random control trials to determine the outcomes of different dosages on ASVD prevention. The approach has proven to be more effective compared to moderate intensity doses such as pravastatin 40 mg, simvastatin 20 mg to 40 mg, or atorvastatin 10 mg twice daily (Stone et al., 2013).

The 2014 NLA Recommendations for Patient-Centered Management of Dyslipidemia recommend that in patients who need lipid lowering drugs, statin therapy should be the primary regimen (Jacobson et al., 2014). Statin has been shown to be beneficial in diabetic patients of between ages 40 and 75 with LDL-C 70-189 mg/dl. Since the patient in this case has a ten-year history of type 2 diabetes and a LDL–C level of 95 mg/dL, the statin regimen would help in the management of her dyslipidemia.

The 2016/2017 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for Additional LDL-lowering recommend additional non-statin therapy use in patients where there are additional indications for their use and when there is a clinical presentation of ASVD (Lloyd-Jones et al., 2017). Apart from obesity, there are no additional clinical symptoms for ASVD. Therefore, non-statin therapy is not necessary for this patient case. Note that in the event that it was necessary, ezetimibe would be the most preferred medication (Lloyd-Jones et al., 2017).

I would first educate the patient concerning her condition, diabetes and hypertension and their predisposition to dyslipidemia. I would inform the patient that artovastatin has a better therapeutic effect on the prevention of atherosclerotic cardiovascular disease. I will also explain to the patient that 40mg of artovastatin is a high intensity dosage necessary for the prevention of ASCVD. I will also provide clear explanation to the patient on how to improve drug adherence for better outcomes.

References

Jacobson, T. A., Ito, M. K., Maki, K. C., Orringer, C. E., Bays, H. E., Jones, P. H., McKenney, J. M., Grundy, S. M., Gill, E. A., Wild, R. A., Wilson, D. P., & Brown, W. V. (2014). National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 – executive summary. Journal of Clinical Lipidology, 8(5), 473–488. doi:10.1016/j.jacl.2014.07.007
Lloyd-Jones, D., Morris, P., Ballantyne, C., Birtcher, K., Daly, D., & DePalma, S. M., Minissian, M. B., Orringer, C. E., & Smith, S. C. (2017). 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk. Journal Of The American College Of Cardiology, 70(14), 1785-1822. https://doi.org/10.1016/j.jacc.2017.07.745
Stone, N., Robinson, J., Lichtenstein, A., Bairey Merz, C., Blum, C., & Eckel, R. H., Goldberg, A. C., Gordon, D., Levy, D., Lloyd-Jones, D.M., McBride, P., Swartz, J. S., Shero, S. T., Smith, S. C., Watson, K. & Wilson, P. W. F. (2013). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation, 129(25 suppl 2), S1-S45. https://doi.org/10.1161/01.cir.0000437738.63853.7a