Endocrinology

Lipid Disorders

Questions discussed in this category

When do you think physicians should seriously consider prescribing PCSK9 inhibitors for the prevention of heart attack and stroke in people with ASCVD or diabetes, based on the results of the VESALIUS-CV trial?

Bohula et al., PMID 41211925

1 Answer available

Would you consider transitioning patients older than 75 years of age with coronary disease from statins and/or other lipid-lowering agents to PCSK9 inhibitors given concerns for polypharmacy, provided their LDL levels remain at or below goal?

2 Answers available

Would you consider PCSK9 inhibitors for patients with elevated coronary calcium score or coronary calcification for primary prevention in lieu of statins/ezetimibe and/or bempedoic acid?

2 Answers available

What patient factors do you consider when selecting between a small interfering RNA, like inclisiran, and PCSK9 inhibitors in patients with recent acute coronary syndrome?

2 Answers available

In patients with MASLD, would you consider management with off-label metformin, pioglitazone (despite weight gain risk), GLP-1 RA, or simply intensify lifestyle and monitor?

If you prefer monitoring strategy, how frequently do you repeat labs and what is your referral thresholds to hepatology if you're practicing in primar...

1 Answer available

What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?

6 Answers available

Do you start a statin concurrently with icosapent ethyl for patients with moderate hypertriglyceridemia and high ASCVD risk, or do you prefer to start a statin alone and monitor triglyceride levels?

Moderate hypertriglyceridemia is defined here as a triglyceride level of 150-499 mg/dL.

2 Answers available

What is your approach to the management of incidentally elevated HDL levels in isolation and is there any utility for further ASCVD risk stratification and/or genetic testing for lipid disorders?

1 Answer available

How do you counsel patients with metabolic syndrome who decline statin therapy and have low coronary calcium scores regarding their long-term CVD risk?

3 Answers available

In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?

How would you adjust statin therapy in these patients?

5 Answers available

When can we consider deferring an insulin drip in patients with hypertriglyceridemia-induced pancreatitis?

If the patient does not have underlying diabetes, do the benefits of an insulin drip for this indication outweigh the risks?

2 Answers available

For a patient with known CAD and low baseline HDL, would a PCSK9 inhibitor be a better option than a statin, given concerns for paradoxical lowering of HDL levels with statin therapy that we can encounter in the outpatient clinical setting?

5 Answers available

What is the clinical significance of a paradoxical decrease in HDL cholesterol after starting statin therapy?

2 Answers available

How often do you recommend performing an advanced lipid panel for monitoring of lipid lowering therapy?

4 Answers available

Under what clinical circumstances, if any, would you prescribe fenofibrate along with statin therapy?

2 Answers available

Is there an available ASCVD risk calculator that does not exclude patients on statin therapy?

Also, is there an ASCVD calculator that can include those with existing ASCVD?

1 Answer available

Is there any difference in the cardiovascular risk reduction profile of brand name Vascepa versus generic icosapent ethyl for patients with hypertriglyceridemia?

1 Answer available

Do you use the homeostatic model assessment (HOMA) to assess for insulin resistance and change your clinical management of patients?

3 Answers available

What other considerations for hyperlipidemia management would you have for a patient with multiple prior PCIs whose LDL remains above goal on high intensity statin, ezetimibe, and evolocumab, assuming the patient is compliant with medications?

3 Answers available

Would you consider adding niacin to the lipid lowering regimen in statin-intolerant patients who cannot afford PCSK9i or bempedoic acid?

Ferrell et al., PMID 38448791

6 Answers available

Will TRYNGOLZA (olezarsen), recently approved for familial chylomicronemia syndrome, also lower triglycerides due to other genetic causes of hypertriglyceridemia?

2 Answers available

Is moderate-intensity statin plus ezetimibe just as effective as high-intensity statin monotherapy in preventing major cardiovascular events?

4 Answers available

Would you recommend statin initiation in a young adult patient (age < 40) with type 1 diabetes mellitus and LDL cholesterol levels greater than 100 without any cardiovascular risk factors?

1 Answer available

When do you recommend plasmapheresis/plasma exchange for management of severe hypertriglyceridemia?

2 Answers available

Do you recommend adding low-dose Aspirin for primary prevention in patients with Type 2 Diabetes on Eliquis for another indication?

1 Answer available

Should all kidney transplant patients be started on statin therapy post operatively given their increased risk of CVD?

At what doses do you start? and how do you titrate therapy?

1 Answer available

Do you recommend the use of bempedoic acid (Nexletol) for treatment of hyperlipidemia in patients with elevated baseline uric acid levels?

Should uric acid levels be monitored regularly while on therapy?

1 Answer available

Should low-intensity statins be favored to minimize the risk of diabetes onset while still offering cardiovascular benefit for patients with prediabetes where a statin is indicated?

Cholesterol Treatment Trialists' (CTT) Collaboration

2 Answers available

For patients with metabolic syndrome, is it reasonable to wait for the effect of tirzepatide therapy on their lipid profile prior to starting statin therapy?

4 Answers available

What is your approach to management of hyperlipidemia in patients taking JAK inhibitors?

1 Answer available

What are the indications for use of inclisiran over anti-PCSK9 monoclonal antibody therapies?

2 Answers available

What are the clinical indications and major limitations of lipoprotein apheresis?

2 Answers available

When and for whom should we consider adding bempedoic acid to the lipid lowering regimen?

3 Answers available

How do you counsel patients with non-statin associated inflammatory myopathies about statin use?

1 Answer available

Should Orlistat be considered in the management of hypertriglyceridemia?

1 Answer available

Would you treat an isolated elevated total cholesterol in a post-menopausal patient who is otherwise healthy and has no significant CV risk factors?

2 Answers available

Should patients with mild subclinical hypothyroidism (TSH < 10 mIU/L) be treated with thyroid hormone replacement to improve their lipid profile?

2 Answers available

Should lipid lowering therapy be started in patients with isolated elevation in lipoprotein (a) and minimal cardiovascular risk?

2 Answers available

Should insulin be started early (prior to optimization of other anti-hyperglycemic medications) in patients with mild-to-moderate diabetes and hypertriglyceridemia refractory to statin and fibrates?

2 Answers available

Papers discussed in this category

Journal of the American Heart Association, 2015 Jun 26

Effects of Exercise Training on Cardiorespiratory Fitness and Biomarkers of Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Mayo Clinic proceedings, 2023 Jun 29

Progression to Insulin Therapy in Patients With Type 2 Diabetes According to Cardiorespiratory Fitness, Body Mass Index, and Statin Therapy.

The Journal of clinical endocrinology and metabolism, 2011 Dec 28

Update in lipid alterations in subclinical hypothyroidism.

Lancet (London, England), 2023 Mar 06

Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials.

Curr Rheumatol Rep, 2020 Aug 26

Lipid-lowering Therapies in Myositis.

The American journal of cardiology, 2004-02-01

Safety and tolerability of simvastatin plus niacin in patients with coronary artery disease and low high-density lipoprotein cholesterol (The HDL Atherosclerosis Treatment Study).

Nature medicine, 2024 Feb 19

A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk.

Journal of clinical lipidology, 2024 Mar 29

A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice.

Journal of the American College of Cardiology, 1986-12

Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin.

The New England journal of medicine, 2011-12-15

Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy.

Current opinion in lipidology, 2007 Aug

Niacin in cardiovascular prevention: mechanisms, efficacy, and safety.

The American journal of cardiology, 2005 Jun 01

Influence of extended-release nicotinic acid on nonesterified fatty acid flux in the metabolic syndrome with atherogenic dyslipidemia.

Trials, 2018 Mar 05

Improved adherence adjustment in the Coronary Drug Project.

The New England journal of medicine, 2014 Jul 17

Effects of extended-release niacin with laropiprant in high-risk patients.

JAMA, 1975 Jan 27

Clofibrate and niacin in coronary heart disease.

N Engl J Med,

Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis.

Autoimmunity reviews, 2023 Dec 20

Implementation of regulatory guidance for JAK inhibitors use in patients with immune-mediated inflammatory diseases: An international appropriateness study.

Stroke, 2007-12

Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack: the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.

The New England journal of medicine, 2006 Aug 10

High-dose atorvastatin after stroke or transient ischemic attack.

European heart journal, 2020 Jan 01

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.

Journal of the American Heart Association, 2023 Sep 08

Statin Treatment in Patients With Stroke With Low-Density Lipoprotein Cholesterol Levels Below 70 mg/dL.

The New England journal of medicine, 2011-12-01

Effect of two intensive statin regimens on progression of coronary disease.

Circulation, 2019-06-18

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

The New England journal of medicine, 2019-01-03

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia.

The New England journal of medicine, 2024 Apr 07

Olezarsen for Hypertriglyceridemia in Patients at High Cardiovascular Risk.

Journal of clinical lipidology, 2022 Sep 11

Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association.

International journal of pancreatology : official journal of the International Association of Pancreatology, 1991 Nov-Dec

Hyperlipidemia in acute pancreatitis. Relationship with etiology, onset, and severity of the disease.

Ophthalmology, 2014-12

The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study.

Lancet (London, England), 2007 Nov 07

Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial.

NEJM evidence, 2024 Jun 21

Effect of Fenofibrate on Progression of Diabetic Retinopathy.

Circulation. Cardiovascular imaging, 2023 Jun 08

Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial Fibrillation.

The New England journal of medicine, 2025 Nov 08

Evolocumab in Patients without a Previous Myocardial Infarction or Stroke.

Journal of the American College of Cardiology, 2022 Mar 01

Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk.

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