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Lipid Management in Endocrine Disorders

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Key Points 2 ➤ Obtain a lipid panel in adults with endocrine disorders to assess triglyceride (TG) levels and to calculate LDL cholesterol (LDL-C). ➤ Treat adults with type 2 diabetes (T2D) and other cardiovascular (CV) risk factors with a statin in addition to lifestyle modifications, aiming for an LDL-C goal of <70 mg/dL. ➤ Consider statin therapy, irrespective of the CV risk score, in adults with type 1 diabetes who are age 40 years and older, or have a history of diabetes of at least 20 years, or either microvascular complications, chronic kidney disease (CKD) stages 1-4, or obesity. ➤ Rule out hypothyroidism in patients with hyperlipidemia before treatment with lipid lowering medications. In patients with hypothyroidism re- evaluate the lipid profile when the patient is euthyroid. ➤ Consider statin therapy as adjunct to lifestyle modifications in adults with persistent endogenous Cushing's syndrome or adults taking chronic glucocorticoid therapy above replacement levels. ➤ For treatment of dyslipidemia in post-menopausal women, use statins, rather than hormone therapy, because statins reduce atherosclerotic cardiovascular disease (ASCVD). ➤ Evaluate and treat lipids and other CV risk factors in women who enter menopause early (before the age of 40-45 years). Assessment 1. Screening and Cardiovascular Disease Risk Assessment Measurement of Lipids ➤ 1.1 In adults with endocrine disorders, we recommend a lipid panel for the assessment of TG levels and for calculating LDL-C. (1|⊕⊕⊕ ) Technical Remarks: ▶ Non-fasting lipid panels are acceptable for initial screening. ▶ If TG levels are elevated or if genetic dyslipidemia is suspected, repeat a fasting lipid panel. ▶ If lipoprotein(a) [Lp(a)] levels are measured, fasting or non-fasting samples can be obtained.

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