10-07-2010, 08:02 PM
my ans:
1 + nonpharmacologic measures.
--------------------------------------------------------
here is my hard work from CMDT, ATPIII and Washington manual:
management of high TG with or without high LDL:
1) triglycerides of 400 mg/dL or less
and elevated LDL cholesterol levels ------- statin + nonpharmacologic measures.
2 if the triglycerides are above 400 mg/dL despite adequate dietary modifications and exercise, the choice
a statin at higher doses,
gemfibrozil,
fenofibrate,
niacin,
or omega-3 fatty acids.
3) For patients with triglycerides over 1,000 mg/dL-------- DOC: fibrates and niacin
If LDL cholesterol levels remain high after the triglycerides are lowered,
combination therapy -------------- S/E: myopathy and rhabdomyolysis
----statin+ niacin (better side effect profile than other)
---or, statin + fibrinate
The combination of a fibrate and statin should be avoided in patients with
renal insufficiency,
congestive heart failure,
severe debility,
or other conditions,
which may affect the metabolism of medications.
Patients whose triglycerides remain above 200 mg/dL
---------- non-HDL cholesterol evaluated as a secondary goal of therapy
If non-HDL cholesterol is not at goal, therapeutic lifestyle changes should be emphasized.
The dose of statin can be increased or a second medication such as ezetimibe can be added.
1 + nonpharmacologic measures.
--------------------------------------------------------
here is my hard work from CMDT, ATPIII and Washington manual:
management of high TG with or without high LDL:
1) triglycerides of 400 mg/dL or less
and elevated LDL cholesterol levels ------- statin + nonpharmacologic measures.
2 if the triglycerides are above 400 mg/dL despite adequate dietary modifications and exercise, the choice
a statin at higher doses,
gemfibrozil,
fenofibrate,
niacin,
or omega-3 fatty acids.
3) For patients with triglycerides over 1,000 mg/dL-------- DOC: fibrates and niacin
If LDL cholesterol levels remain high after the triglycerides are lowered,
combination therapy -------------- S/E: myopathy and rhabdomyolysis
----statin+ niacin (better side effect profile than other)
---or, statin + fibrinate
The combination of a fibrate and statin should be avoided in patients with
renal insufficiency,
congestive heart failure,
severe debility,
or other conditions,
which may affect the metabolism of medications.
Patients whose triglycerides remain above 200 mg/dL
---------- non-HDL cholesterol evaluated as a secondary goal of therapy
If non-HDL cholesterol is not at goal, therapeutic lifestyle changes should be emphasized.
The dose of statin can be increased or a second medication such as ezetimibe can be added.