Algorithm and Annotations
#2 A new box was added, "Initiate Lifestyle Modification". This corresponding annotation verbiage was moved up from later in the guideline to stress the importance of addressing lifestyle changes first when a patient with dyslipidemia is seen initially. To the section on Diet, plant stanols/sterols information was added.
#3 The annotation contains a link to the NCEP ATP III most recent 10 year risk calculator. One of the risk factors for CHD was amended by removing women with premature menopause without HRT. Hormone Therapy does not significantly reduce the risk of CHD events.
#5, #6 Boxes give an option of initiating drug therapy if the LDL level is at or greater than goal rather than at a higher level.
#8 In the section on recommendations for those who cannot take statins, information has been added about myalgias and myopathy.
#10 Both the box and the annotation remind the clinician that if the patient's LDL goal is not met with initial therapy, Adherence and changes in lifestyle modifications should be addressed.
Appendices:
C "Drug Companion Document". Revised statement on rosuvastatin. Added atorvastatin as one that does not have dose restrictions when combined with gemfibrozil. A new fibrate, fenofibrate acid was added. Niacin-statin combinations were added. The section on bile acid sequestrants has been revised. Cost information for statins was updated.
Alvarez, CA Combination Thiazolidinedione and fibrate effect on high-density lipoprotein cholesterol (HDL-C) concentration in a Veterans Affairs patient population. A retrospective study.
Grundy, SM Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines
Kastelein, JP Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia. The ENHANCE study (RCT)
Lavie, CJ Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases. A systematic review of 4 clinical trials.
Mymin, D Iatrogenic Severe Depression of High-Density Lipoprotein Cholesterol. A review of cases.
Normen, L Combination Therapy with Fenofibrate and Rosiglitazone Paradoxically lowers serum HDL Cholesterol. Retrospective review.
O'Neill, FH Comparison of Efficacy of Plant Stanol Ester and Sterol Ester: Short-Term and longer-Term Studies. Meta-analysis
Rossebo, AB Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis. The SEAS study group. (RCT)
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