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Lipid Management in Patients with Endocrine Disorders: an Endocrine

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Lipid Management in Patients with Endocrine Disorders: an Endocrine The Journal of Clinical Endocrinology & Metabolism, 2020, Vol. 105, No. 12, 1–70 doi:10.1210/clinem/dgaa674 Clinical Practice Guideline Clinical Practice Guideline Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Downloaded from https://academic.oup.com/jcem/article/105/12/dgaa674/5909161 by guest on 28 October 2020 Guideline Connie B. Newman,1 Michael J. Blaha,2 Jeffrey B. Boord,3 Bertrand Cariou,4 Alan Chait,5 Henry G. Fein,6 Henry N. Ginsberg,7 Ira J. Goldberg,1 M. Hassan Murad,8 Savitha Subramanian,5 and Lisa R. Tannock9 1Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, New York 10016; 2Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland 21287; 3Department of Administration and Parkview Physicians Group Endocrinology Section, Parkview Health System, Fort Wayne, Indiana 46845; 4Department of Endocrinology, L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, F-44000, France; 5Department of Medicine, University of Washington, Seattle, Washington 98109; 6Department of Medicine, Division of Endocrinology, Sinai Hospital, Baltimore, Maryland 21215; 7Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York 10032; 8Mayo Clinic Evidence-based Practice Center, Rochester, Minnesota; and 9Department of Internal Medicine, University of Kentucky, Lexington, Kentucky 40536 ORCiD number: 0000-0001-9144-056X (C. B. Newman). Co-Sponsoring Organizations: European Society of Endocrinology. Abbreviations: AACE, American Association of Clinical Endocrinologists; ACC, American College of Cardiology; ADA, American Diabetes Association; AHA, American Heart Association; ALT, alanine aminotransferase; AMP, adenosine monophosphate; AMPK, AMP-activated protein kinase; apo, apolipoprotein; apoA, apolipoprotein A; apoB, apolipoprotein B; apoE, apolipoprotein E; AST, aspartate aminotransferase; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CAC, coronary artery calcium; CAD, coronary artery disease; CETP, cholesteryl ester transfer protein; cIMT, carotid intima-media thickness; CHD, coronary heart disease; CK, creatine kinase; CKD, chronic kidney disease; COI, conflicts of interest; CRP, c-reactive protein; CT, computed tomography; CTT, Cholesterol Treatment Trialists; CV, cardiovascular; CVD, cardiovascular disease; CYP3A4, cytochrome P450 3A4; DHA, dososahexanoic acid; DPA, docosapentaenoic acid; EPA, eicosapentaenoic acid; ESRD, end-stage renal disease; FDA, U.S. Food and Drug Administration; FFA, free fatty acid; FH, familial hypercholesterolemia; FSH, follicle-stimulating hormone; GHD, growth hormone deficiency; GI, gastrointestinal; GLP-1, glucagon-like peptide; HbA1c, hemoglobin A1c; HCG, human chorionic gonadotropin; HDL, high-density lipoprotein; HDL-C, high-density lipoprotein cholesterol; hsCRP, high-sensitivity C-reactive protein; HR, hazards ratio; IGF-1, insulin- like growth factor 1; LT3, L-triiodothyronine; LT4, levothyroxine; LCAT, lecithin cholesterol acyltransferase; LDL, low-density lipoprotein; LDL-C, low-density lipoprotein cholesterol; LH, luteinizing hormone; Lp(a), lipoprotein(a); LPL, lipoprotein lipase; MACE, major adverse cardiac event; MetS, metabolic syndrome; MI, myocardial infarction; NLA, National Lipid Association; NRI, net reclassification index; OCP, oral contraceptive; PCOS, polycystic ovary syndrome; PCSK9, proprotein convertase subtilisin/kexin type 9; RCT, randomized-controlled trial; RR, relative risk; RRR, relative risk reduction; RYGB, Roux-en-Y gastric bypass; SBGH, sex hormone–binding globulin; SCH, subclinical hypothyroidism; SCORE, Systemic Coronary Risk Evaluation; SG, sleeve gastrectomy; SGLT2, sodium-glucose co-transporter 2; T1D, type 1 diabetes; T2D, type 2 diabetes; TG, triglycerides; TSH, thyroid-stimulating hormone; ULN, upper limits of normal; VLDL, very low-density lipoprotein. ISSN Print 0021-972X ISSN Online 1945-7197 Printed in USA © The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: [email protected] https://academic.oup.com/jcem 1 The Journal of Clinical Endocrinology & Metabolism, 2020, Vol. 105, No. 12 2 Received: 5 August 2020; Accepted: 17 September 2020; First Published Online: 19 September 2020; Corrected and Typeset: 28 October 2020. Abstract Objective: This guideline will provide the practicing endocrinologist with an approach to the assessment and treatment of dyslipidemia in patients with endocrine diseases, with the objective of preventing cardiovascular (CV) events and triglyceride- induced pancreatitis. The guideline reviews data on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with endocrine disorders and discusses the evidence for the correction of dyslipidemia by treatment of the endocrine disease. The guideline also addresses whether treatment of the endocrine disease reduces Downloaded from https://academic.oup.com/jcem/article/105/12/dgaa674/5909161 by guest on 28 October 2020 ASCVD risk. Conclusion: This guideline focuses on lipid and lipoprotein abnormalities associated with endocrine diseases, including diabetes mellitus, and whether treatment of the endocrine disorder improves not only the lipid abnormalities, but also CV outcomes. Based on the available evidence, recommendations are made for the assessment and management of dyslipidemia in patients with endocrine diseases. Freeform/Key Words: endocrine diseases, lipids, triglycerides, cardiovascular disease, dyslipidemia, diabetes List of Recommendations 1.3 In adults with endocrine disorders at borderline 1. Screening and cardiovascular disease risk or intermediate risk (10-year atherosclerotic assessment cardiovascular disease risk 5%–19.9%), particularly those with additional risk-enhancing factors, in whom the decision about statin treatment and/ Measurement of lipids or other preventive interventions is uncertain, we suggest measuring coronary artery calcium to 1.1 In adults with endocrine disorders, we recommend inform shared decision making. (2⊕⊕⊕O) a lipid panel for the assessment of triglyceride levels and for calculating low-density lipoprotein Technical Remarks: cholesterol. (1 O) ⊕⊕⊕ • Borderline and intermediate cardiovascular risk are defined as 5%–7.4% and 7.5%–19.9% 10-year Technical Remarks: atherosclerotic cardiovascular disease risk using the • Non-fasting lipid panels are acceptable for initial Pooled Cohort Equations. screening. • Risk-enhancing factors are additional features, including • If triglyceride levels are elevated or if genetic dyslipidemia diseases, that enhance the risk of atherosclerotic is suspected, repeat a fasting lipid panel. cardiovascular disease beyond the risk associated with • If lipoprotein(a) levels are measured, fasting or major risk factors and/or the calculated 10-year risk of nonfasting samples can be obtained. atherosclerotic cardiovascular disease. • In patients with additional risk-enhancing factors, Cardiovascular risk assessment including elevated lipoprotein(a), as described below, risk assessment should consider traditional 10-year 1.2 In adults with endocrine disorders, we recommend atherosclerotic cardiovascular disease risk assessment conducting a cardiovascular risk assessment and the presence of risk-enhancing factors. The coronary by evaluating traditional risk factors, including artery calcium score should be considered when risk the calculation of 10-year atherosclerotic assessment and treatment decisions remain uncertain. cardiovascular disease risk using a tool such as the • At present, we suggest measuring coronary artery Pooled Cohort Equations. (1⊕⊕⊕O) calcium as the preferred tool for assessment of subclinical atherosclerosis. Other techniques to assess atherosclerotic burden are being developed. 3 The Journal of Clinical Endocrinology & Metabolism, 2020, Vol. 105, No. 12 • Coronary artery calcium = 0 marks very low risk of 2.2 In patients with triglyceride-induced pancreatitis, atherosclerotic cardiovascular disease. In patients with we suggest against the use of acute plasmapheresis baseline coronary artery calcium = 0, evidence suggests as a first-line therapy to reduce triglyceride levels. that it is reasonable to repeat a coronary artery calcium (2⊕OOO) scan after 5 to7 years in low-risk patients, 3 to 5 years in borderline-to-intermediate risk patients, and in 3 years Technical Remark: for high-risk patients or those with diabetes. • Plasmapheresis may be useful in those who do • In patients without diabetes or atherosclerotic not respond to conventional methods of lowering cardiovascular disease and with low-density lipoprotein triglycerides, such as individuals who have >70 mg/dL (1.8 mmol/L), and 10-year atherosclerotic extraordinarily elevated triglyceride levels (eg, over cardiovascular disease risk >7.5%, or 10-year 10 000 mg/dL [112.9 mmol/L]) or in extremely high- Downloaded from https://academic.oup.com/jcem/article/105/12/dgaa674/5909161 by guest on 28 October 2020 atherosclerotic cardiovascular disease risk of 5% to risk situations, such as pregnancy. 7.4% plus 1 or more risk-enhancing factors, or coronary artery calcium score over the 75th percentile for age, sex, 2.3 In patients without diabetes and who have and race, or coronary artery calcium score >100, the triglyceride-induced pancreatitis, we suggest initiation of a statin, as
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