4-5: LDL of 190+ and Diabetes Benefit Groups

LDL of 190+: Provide the values for someone within this scenario-

LDL of 190+ on HI Statin

• Goal: ? decrease in LDL

• LDL Threshold: ?

• Non-HDL: ?

• 50% +

• 100 or less

• 130 or less

LDL of 190+: Provide the additional non-statin therapies for someone within this scenario-

LDL of 190+ on HI Statin

• 1st line therapy ?

• 2nd line therapy ?

• 3rd line therapy ?

• ezetimibe and or pcsk9i → whichever not added above

• bempedoic acid or inclisiran

• evinacumab, lomatipide, and/or LDL apheresis if history of familial hypercholesterolemia

Diabetes: If a patient is in the age range of 40-75 years old, what is the statin intensity you can use for treatment INITIALLY?

moderate intensity

Diabetes: Provide the values for someone within this scenario-

Diabetes → lifestyle → 40-75 years old → moderate/ high intensity statin

• Goal: ? decrease in LDL

• LDL Threshold: ?

• Non-HDL: ?

• 30% +

• 100 or less

• 130 or less

Diabetes: After initiating initial treatment, what do you do if the patient is not at goal?

calculate their ASCVD score

Diabetes: What are the 3 treatment pathways based on ASCVD risk score?

1. 7.5% or less

2. 7.5% + or multiple DM-specific risk enhancing factors (high risk)

3. 20% or more

Diabetes: What are the 7 DM-specific risk enhancing factors?

1. 10+ year duration of type 2

2. 20+ year duration of type 1

3. albuminuria of 30+

4. eGFR less than 60

5. retinopathy (eye damage)

6. neuropathy (nerve damage)

7. ABI less than 0.9

Diabetes: What is the treatment pathway for someone with ASCVD risk score of 7.5% or less?

remain on moderate intensity statin AND continue to monitor

Diabetes: What is the treatment pathway for someone with an ASCVD risk score of 7.5% or more OR with multiple DM-specific REFs?

• initiate ? intensity statin

THEN

• Goal: ? decrease in LDL

• LDL Threshold: ?

• Non-HDL: ?

• high intensity statin

  THEN

• 50% or more

• 70 or less

• 100 or less

Diabetes: What is the treatment pathway for someone with an ASCVD risk score of 20% or more?

• initiate ? intensity statin

  THEN

• Goal: ? decrease in LDL

• LDL Threshold: ?

• Non-HDL: ?

  THEN

• add ?

• high intensity statin

  THEN

• 50% or more

• 70 or less

• 100 or less

  THEN

• add ezetimibe

Diabetes: When is the only time that additional non-statin therapy is used and which treatment is added?

If a patient has diabetes w/ a ASCVD risk score of 20% or higher and has not reached goal after initiating a high intensity statin.

• Only ezetimibe is added