Dyslipidemia is defined as having blood lipid levels that are too high or low. Lowering blood cholesterol levels using statins is recommended to reduce the impact of cardiovascular morbidity and mortality

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

Simvastatin 10mg/20mg oral once daily

OR

Atorvastatin 20mg daily

OR

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

• 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