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Tara Dall , MD Advanced Lipidology Delafield, Wisconsin

Advances in Statin Therapy: Expert Recommendations for Optimizing the Management of Dyslipidemia in the Clinically Complex Patient. Tara Dall , MD Advanced Lipidology Delafield, Wisconsin Diplomate , American Board of Clinical Lipidology.

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Tara Dall , MD Advanced Lipidology Delafield, Wisconsin

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  1. Advances in Statin Therapy: Expert Recommendations for Optimizing the Management of Dyslipidemia in the Clinically Complex Patient Tara Dall, MD Advanced Lipidology Delafield, Wisconsin Diplomate, American Board of Clinical Lipidology

  2. 53 yr old male HTN, Dyslipidemia, RA and family history premature CAD

  3. 53 yr old Male HTN, dyslipidemia, RA • 53y/o male with hxlow HDL and high triglycerides and history of elevated LFTS, prior statin intolerance not on any lipid therapy • PMH:HTN, rheumatoid arthritis, IFG • Medications: Aspirin 81, Entanercept, Bisoprolol, Hydrochlorothiazide • No lipid meds due to statin intolerance (simvastatin and atorvastatin) which caused myalgias, elevated liver enzymes • Family history: Father died age 51 MI

  4. Physical Exam • Wt235 lbs • Ht 71 in • WC 45 in • BMI 32 • No evidence of tendinousxanthomas or corneal arcus

  5. Initial Labs Lipids/lipoproteins Other markers Lipoprotein (a) 25 mg/dl (normal) hs-CRP 3 mg/L LpPLA2 177 ng/mL (optimal <200) Myeloperoxidase 309 (normal) • T Cholesterol 210 mg/dL • TG 183 mg/dL • HDL-C 37 mg/dL • LDL-C 143 mg/dL • non-HDL-C 173 mg/dL • LDL-P 3021 nmol/L • small LDL-P 2813 nmol/L • Apo B 124 All lipid and lipoprotein measurements in abnormal range

  6. Other Labs

  7. Issues to Address • Previous myalgias on simvastatin and atorvastatin? • Drug alternatives? • Elevated LFTs? Does this impact treatment options? • Any additional therapies • Vitamin D • Coenzyme Q 10 • Impaired glucose? Role for treatment? • Medication options • Optimization of diet

  8. Approach to Selection of Drug Therapies for Lipids • Rationale for which statin and what dose to try next? • What other lipid-modifying drugs would you add? • In what order would you add them? • Any medications contraindicated?

  9. Follow up visit 3 months

  10. Issues to Address • Any additional therapies • LDL-C 68, LDL –P 1461 • HDL-C 26 • Weight loss of 18 pounds, BMI 30 down from 32 • If he develops myalgias in future on rosuvastatin what to do next?

  11. Conclusions • Many patients who are intolerant of common statins can tolerate those with a more favorable pharmacokinetic profile. • Combination therapy is often required to achieve lipid goals. • Lifestyle modification and addressing insulin resistance/pre-diabetes is important.

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