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.