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20.2 Management of Dyslipidemias

Table of Contents

Lowering blood cholesterol levels using statins is recommended to reduce the impact of cardiovascular morbidity and mortality

Clinical indication for lipid lowering medicine therapy

  • Established atherosclerotic disease
  • Ischaemic heart disease
  • Peripheral vascular disease
  • Atherothrombotic stroke

Note: Lipid lowering medicines should be administered in this setting even if the level of cholesterol is normal

  • Type 2 diabetics > 40 years of age, or diabetes for > 10 years,
  • Existing cardiovascular disease, or
  • Chronic kidney disease (eGFR < 60 mL/min).
  • CV risks of more than > 20% in 10 years Such high-risk patients will benefit from lipid lowering (statin) therapy irrespective of their baseline LDL levels.

Pharmacological Treatment

C: Simvastatin 10mg/20mg oral once daily

OR

D: Atorvastatin 20mg daily

OR

D:Rosuvastatin 10mg-40mg daily

Note:
Lipid lowering medicine therapy for patients taking protease inhibitors
Certain antiretroviral medication, particularly protease inhibitors, can cause dyslipidaemia. Fasting lipid levels should be done 3 months after starting lopinavir/ritonavir. Lopinavir/ritonavir is associated with a higher risk of dyslipidaemia than atazanavir/ritonavir.
Patients at high risk (> 20% risk of developing a CVS event in 10 years) should switch to atazanavir/ritonavir and repeat the fasting lipid profile in 3 months.
Patients with persistent dyslipidaemia despite switching, qualify for lipid lowering therapy

Criteria for initiating lipid lowering therapy are the same as for HIV uninfected patients.

Key Point.

  • Statins can be initiated at Health Centre/District Hospital by a doctor after assessing cardiovascular risks as stipulated above.

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