Content :
Screening is indicated in
Friedewald Formula (in patients with TG ≤ 400 or LDL ≤ 50)
$$ LDL=Total \ Cholesterol\ -\ HDL \ -\ \frac{TG}{5} $$
Non-HDL Equation only in patients with hypertriglyceridemia
$$ Non\ HDL=Total \ Cholesterol \ - \ HDL $$
Lifestyle modifications should be initiated 3-6 months prior to consideration of prescription except those with familial hypercholesterolemia. Indications are
| Indication | Goal | Initial Statin |
|---|---|---|
| Age ≥ 21—LDL ≥ 190 | LDL < 100 and 50% decrease from initial LDL | Moderate (if goal not achieved in 4-12 weeks then high intensity) |
| Familial Hypercholesterolemia | LDL < 70 and 50% decrease from initial LDL | High (if goal not achieved in 4-12 weeks then add Ezetimibe, if no response then consider PSCK9-i) |
| Age ≥ 35—LDL < 190 with no other risks | Lifestyle modifications | |
| Age ≥ 35—LDL < 190 with 10-Year CV Risk ≥ 10% | LDL < 100 and 30% decrease from initial LDL | Low to moderate |
| Age ≥ 35—LDL < 190 with 10-Year CV Risk < 10% with subclinical ASCVD, CAC > 100, ABI < 0.9, chronic inflammation or first-degree relative with premature ASCVD | LDL < 100 and 30% decrease from initial LDL | Low to moderate |
| Age ≥ 40 with DM and 0-1 risk factors | LDL < 100 and 30-50% decrease from initial LDL | Moderate |
Dietary Control
General Considerations
LDL reduction
TG reduction
*Familial chylomicronemia syndrome : fat 10-15 g/d with medium chain TG oil 30 g/d
Other Modalities
[ ] Moderate aerobic exercise : เดินเร็ว วิ่งเหยาะ ว่ายน้ำ ปั่นจักรยาน 150-300 นาที
“ให้พูดประโยคแบบพอหอบ ๆ เริ่มที่ 30 นาทีต่อวัน 5 วันต่อสัปดาห์”
[ ] Smoking cessation