Hyperlipidemia

Hyperlipidemia screening and treatment criteria are governed by ACC/AHA cholesterol guidelines using a risk-based approach. Universal lipid screening is recommended at age 20 and every 4-6 years thereafter (more frequent with risk factors). Fasting lipid panel includes: total cholesterol, LDL-C (primary treatment target), HDL-C, triglycerides, and calculated non-HDL-C (total - HDL = LDL + VLDL — used when triglycerides >400 mg/dL make Friedewald LDL calculation inaccurate). The 10-year ASCVD risk calculator (Pooled Cohort Equations) uses age, sex, race, total cholesterol, HDL, systolic BP, BP treatment, diabetes, and smoking status. Four statin benefit groups: (1) Clinical ASCVD (secondary prevention) — high-intensity statin for ALL regardless of LDL; (2) LDL ≥190 mg/dL (likely familial hypercholesterolemia) — high-intensity statin without calculating risk score; (3) Diabetes ages 40-75 — at minimum moderate-intensity statin; high-intensity if 10-year risk ≥7.5%; (4) 10-year ASCVD risk ≥7.5% ages 40-75 — moderate-to-high intensity statin. Risk enhancers (used when decision is uncertain in borderline risk 5-7.5%): family history of premature ASCVD, metabolic syndrome, CKD, inflammatory conditions (RA, lupus, psoriasis, HIV), South Asian ancestry, elevated hsCRP ≥2, elevated Lp(a), ABI <0.9,...