Skip to Main Content

PATIENT CARE PROCESS

Patient Care Process for the Management of Dyslipidemias

Image not available.

Collect

  • Patient characteristics (e.g., age, race, gender, pregnant)

  • Patients history: Past medical (e.g., HTN), family (e.g., early-onset CHD), social

  • Current medications (including OTC) and prior lipid-lowering medication use

  • Socioeconomic factors that may affect access to treatment or other aspects of care

  • Lifestyle assessment: smoking status, exercise and diet, alcohol intake

  • Symptoms indicative of ischemic injury (e.g., chest pain)

  • Objective data

    • Height, weight, BMI, and blood pressure

    • Lipoprotein concentrations (e.g., total cholesterol/LDL-C/HDL-C/triglycerides)

    • Labs (e.g., AST/ALT, UA, TSH, glucose, serum creatinine, and BUN at baseline)

Assess

  • Rule out secondary causes (e.g., diabetes mellitus, alcohol abuse, renal dysfunction, liver disease, drug-induced, thyroid disorder)

  • Assess groups with special considerations such as children/adolescents, pregnant or menopausal women, older adults, ethnic/racial groups, or high-risk conditions/residual risks (e.g., patients with rheumatoid arthritis or residual risk despite statin and lifestyle therapy).

  • Presence of high-risk, co-morbid conditions: Diabetes mellitus, peripheral arterial disease, coronary artery disease, chronic kidney disease, carotid artery stenosis, abdominal aortic aneurysm

  • Dyslipidemia-related complications (e.g., heart disease, stroke)

  • 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment (only if primary prevention)

  • Current medications that may contribute to dyslipidemia

  • LDL-C reduction based on statin benefit group, if applicable to patient (see Table 21-7)

  • Appropriateness and effectiveness of current lipid-lowering therapy (if any)

Plan*

  • Tailored therapeutic lifestyle changes (e.g., diet and nutrition; see Table 21-10)

  • Drug therapy regimen including specific lipid-lowering medication, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 21-13)

  • Monitoring parameters including efficacy (e.g., lipid panel, cardiovascular events), safety (medication-specific adverse effects), and timeframe (3-month initial follow-up intervals, followed by 6-12 month intervals once at goal

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Self-monitoring of weight, exercise, diet, drug adherence/adverse effects

  • Referrals to other providers when appropriate for coordination of care (e.g., physician, dietician)

Implement*

  • Provide patient education regarding all elements of treatment plan, including self-management training

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up and timeframe to achieve goals of therapy

Follow-up: Monitor and Evaluate

  • Determine response to lipid-lowering therapy and weight-loss goals

  • Presence of medication-induced adverse effects (e.g., elevated transaminases or myalgia on statins)

  • Occurrence of CV events

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 8. Dyslipidemia.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Hypercholesterolemia, elevated low density lipoprotein, and low high density lipoprotein are unequivocally linked to increased risk for coronary heart disease (CHD) and cerebrovascular morbidity and mortality; LDL is the primary target.

  • Image not available. Multiple genetic abnormalities and environmental factors are involved in clinical lipid abnormalities and routinely used clinical laboratory measurements do not define the underlying abnormalities.

  • Image not available. Initial therapy for any lipoprotein disorder is therapeutic life-style ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.