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Cholesterol Management Update

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Overview

Several approaches to cholesterol management have traditionally been used, including "treat-to-target" and "lower is better." In 2001, the National Cholesterol Education Program (NCEP) issued a guideline on cholesterol management that was most recently updated in 2004. The guideline set specific LDL targets for treatment in different risk groups. In November of 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) published an updated cholesterol guideline to help providers reduce the overall risk for atherosclerotic cardiovascular disease (ASCVD). As in the previous guideline, lifestyle measures such as a heart-healthy diet, regular exercise, avoiding tobacco products, and maintaining a healthy weight remain the foundation for risk reduction (see the Patient Connection). However, the 2013 recommendations for drug treatment (specifically, statin use) represent a paradigm shift. The 2013 guideline features the elimination of LDL and non-HDL treatment targets; the identification of 4 statin benefit groups with corresponding recommendations for the intensity of statin treatment; the introduction of a new cardiovascular (CV) risk assessment calculator, to estimate 10-year ASCVD risk; and safety recommendations, including management of statin side effects. The new guideline has been the subject of intense controversy.

This issue of The Rx Consultant presents the guideline’s background, its key recommendations for treatment and for safety monitoring, and a discussion of the controversy it caused. You'll also find additional statin information (updated since our 2006 issue) including key differences among agents.

Details

Publication Date: 02/18/2014
Expiration Date: 02/18/2017
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Michelle M. Lamb, Jessica M. Downes, Kelsey T. Lackey

Disclosure Statement

Dr. Lamb, Dr. Downes, and Dr. Lackey report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Outline the main differences between the 2013 ACC /AHA cholesterol management guideline and the previous NCEP guideline. Discuss the controversy about the new guideline.
    2. Describe the 4 statin benefit groups identified in the 2013 guideline, and the recommended intensity of statin therapy for each. List at least 2 regimens of each intensity.
    3. Discuss monitoring for statin response and adverse effects. Provide 1-2 patient counseling tips about myopathy, liver dysfunction, cognitive impairment and new-onset diabetes.
    4. List at least 3 drug interactions that may affect statin levels and/or increase the risk of myopathy.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-14-004-H01-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

Technical Specifications

Hardware requirements

Any hardware that supports Microsoft Windows, Apple Mac OS, iOS, or Android, and meets the software requirements.

Software requirements

Browser that supports TLS 1.1 + and PDF files.

This includes Microsoft Internet Explorer 11, Google Chrome 38, Google Android OS 5.0 Browser, Apple Safari (version 7 for desktop, 5 for mobile), Mozilla Firefox 27, newer versions of these browsers, as well as some earlier versions that may require additional configuration.

Adobe Acrobat Reader is recommended, and is required for some browsers.

Note: TLS 1.1 and 1.2 support is required for browser security. Click here for TLS browser support details.

Internet Connectivity

Required. Broadband recommended. (T1, DSL, Cable, G4 or higher.)

Contact Us

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The Rx Consultant
rxmail@rxconsultant.com
1-800-798-3353

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The Rx Consultant
editor@rxconsultant.com
1-800-798-3353

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