Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline
Hormones regulate every pathway involved in lipoprotein metabolism. Hence, it is predicted that endocrine disease might enhance atherosclerotic cardiovascular disease (ASCVD) risk. There exists limited scientific evidence for appropriate cholesterol management of the rare endocrine disease. The author Newman and colleagues (2020) published evidence-based guidelines in The Journal of Clinical Endocrinology & Metabolism, titled “Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline”.
In continuation to lipid management guidelines covered in the previous month, guidelines about obesity, thyroid disease, excess glucocorticoids, and disorders of growth hormone secretion will be discussed in this article.
Objective:
To describe lipid abnormalities and cardiovascular disease (CVD) risk in endocrine diseases.
To investigate the treatment effect of the central endocrine disorder on the lipid profile and/or ASCVD risk.
To investigate the evidence for using lipid-lowering medications, along with diet and physical activity, in individuals with these endocrine diseases.
Method:
Recommendations are made based on currently available clinical evidence and scientific and medical knowledge. Guidelines are divided into three sections. The first section comprises guidelines to address lipid measurement and ASCVD risk assessment. The second section addresses endocrine diseases. The last section of the guideline discusses implementation, including lifestyle therapy, and the potency and safety of lipid-lowering medications.
Findings:
Recommendations for Obesity:
The assessment of body fat distribution along with all components of metabolic syndrome is advised in obese patients to precisely determine the level of cardiovascular disease risk.
Obese individuals are suggested to adopt a healthy lifestyle as first-line treatment to decrease plasma triglycerides and to lower cardiovascular and pancreatitis risk.
In order to guide the administration of lipid-lowering therapy, the assessment of 10-year risk for atherosclerotic cardiovascular disease is recommended for obese individuals.
The reassessment of the lipid profile is suggested to evaluate the risk of cardiovascular disease and pancreatitis inpatient who was on pharmacological therapy for weight reduction.
Measurement of the lipid profile is suggested after bariatric surgery to assess cardiovascular risk in obese individual those have undergone bariatric surgery.
Recommendation for Thyroid Disease:
Before administrating lipid-lowering medications, it is recommended to eliminate hypothyroidism as the cause of hyperlipidemia.
Re-evaluation of lipid profile is recommended after hyperthyroid patient become euthyroid.
In order to assess lipid profile more precisely in patients with overt hypothyroidism, treatment against hyperlipidemia is suggested until the patient becomes euthyroid in patients.
In individuals with subclinical hypothyroidism along with hyperlipidemia, it is suggested to consider thyroxine treatment as a means of reducing low-density lipoprotein levels.
Recommendations for excess glucocorticoids:
Assessment of lipid profile is recommended in patients with Cushing syndrome to recognize cases of dyslipidemia.
Irrespective of the cardiovascular risk score, statin therapy is recommended along with lifestyle modification in patients with persistent endogenous Cushing syndrome.
The recommendation for cardiovascular risk assessment along with the same treatment as in the general population is advised for individuals with cured Cushing syndrome.
The assessment and treatment of lipids and other cardiovascular risk factors is suggested for individuals receiving chronic glucocorticoid therapy above replacement levels.
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