Lipid Management for BDC Clinicians
2.12.20 Accompanying Lipid Document (.docx)
BDC Lipd v13 (.pdf)
Lipid panel ideally done fasting
If non-fasting and triglycerides or LDL elevated, repeat fasting.
Lipid Screening
Age 2-9: Once if family hx hyperlipidemia or early CVD, or if family history unknown.
LDL ≥100, discuss lifestyle and consider nutrition referral.
LDL ≥130, consider referral to lipid clinic at Children’s Hospital.
Age 10-39: Soon after diagnosis (after glycemic control established), if LDL<100 screen every 3-5 years.
Age 40+: Soon after diagnosis (after glycemic control established), Continue at least annually (whether or not on statin).
If on statin, may require more frequent monitoring for dose titration.
Re-check lipids 3 months after initiation of statin therapy or change in dose.
Initiating Statin Therapy
If patient also with hypertriglyceridemia: Consider choosing atorvastatin or rosuvastatin for their triglyceride-lowering-benefits. May require higher dose statin, addition of fibrate or Omega 3 fatty acid.
Baseline labs: AST/ALT, TSH/fT4. (Untreated hypothyroidism may cause hyperlipidemia and can predispose to statin-induced myopathy.)
Discuss lifestyle and consider dietitian referral
Re-check labs: Lipids 3 months later.
CPK: Only check if concern for muscle discomfort, weakness, inflammation, or rhabdomyolysis.
AST/ALT: Only if symptoms of hepatotoxicity (jaundice, abdominal pain, dark-colored urine).
Side Effects / Considerations
Pregnancy Category X (Teratogenic): Cannot be used in pregnancy or while breastfeeding. For reproductive-age women, discuss birth control status prior to starting statin and document birth control use or abstinence.
Hepatic dysfunction: Slight increased risk of hepatotoxicity.
Muscle injury: Increased risk muscle injury. May cause muscle discomfort, weakness, inflammation, or very rarely rhabdomyolysis.
--Rhabdomyolysis (CPK>10x normal or clinical with myoglobinuria or acute renal injury):
Stop statin use.
--Muscle discomfort, Weakness, Inflammation (with or without CPK elevation):
Pause statin until symptoms improve.
Then consider switching statin (to Fluvastatin), lowering dose, every-other-day statin therapy, or weekly rosuvastatin.
Glycemic control: May cause slightly increased blood sugars.
Cognitive Function: There is NO evidence statins cause memory loss
