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Welcome to the Lipid Manager

Terms of Service

Click the Terms tab at the bottom of the app before using the Lipid Manager (“the Product”) to read the full Terms of Service and License Agreement (the “Agreement”) which governs the use of the Product. The Agreement includes, among other detailed terms and conditions, certain disclaimers of warranties by the American College of Cardiology Foundation (“ACCF”) and requires the user to agree to release ACCF from any and all liability arising in connection with your use of the Product. By using the Product, you accept and agree to be bound by all of the terms and conditions set forth in the Agreement, including such disclaimers and releases. If you do not accept the terms and conditions of the Agreement, you may not proceed to use the Product. The Agreement is subject to change from time to time, and your continued use of the Product constitutes your acceptance of and agreement to be bound by any revised terms of the Agreement.

For the Hypertriglyceridemia app:

This app assumes that the patient is currently taking or has attempted to take guideline-directed LDL-C–lowering therapies including statin and nonstatin agents.

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Enter patient's age

Age must be between 20-75

Select triglyceride range

What is patient's 10-year ASCVD risk? Calculate 10-year risk score

CALCULATED RISK SCORE:  %

Select LDL-C range

Advice

 Steps for lowering Triglycerides:

  • Rule out secondary causes    |   
  • Implement very low-fat diet in select patients and optimize lifestyle    |   
  • Optimize glycemic control (in diabetes)
  • Consider fibrate* or prescription omega-3 fatty acids (icosapent ethyl or omega-3 acid ethyl esters) to reduce risk of pancreatitis
  • Consider statin initiation or intensification in appropriate patient management groups

*Fenofibrate is the preferred fibric acid derivative due to better safety profile and fewer drug interactions compared to gemifibrozil.

 Steps for lowering Triglycerides:

  • Rule out secondary causes     |    
  • Optimize diet and lifestyle    |   
  • Optimize glycemic control (in diabetes)
  • See Additional Lifestyle Recommendations section below for in-depth information
  • Initiate or increase intensity of statin therapy and optimize statin adherence

If the patient has persistent fasting hypertriglyceridemia of 500 – 999 mg/dL after the above steps…

  • Emphasize low-fat diet. Reasonable to consider very low-fat diet in select patients, such as those at the higher end of the 500 - 999 mg/dL range, those with a history of pancreatitis, or those with the persistently elevated or increasing triglycerides
  • Increase intensity of statin therapy and optimize statin adherence
  • Consider fibrate* or prescription omega-3 fatty acids (icosapent ethyl or omega-3 acid ethyl esters) to reduce risk of pancreatitis

*Fenofibrate is the preferred fibric acid derivative due to better safety profile and fewer drug interactions compared to gemifibrozil.

 Steps for lowering Triglycerides:

  • Rule out secondary causes    |   
  • Optimize diet and lifestyle    |   
  • Optimize glycemic control
  • Maximize statin therapy, preferably high-intensity statin, and optimize statin adherence

If the patient has persistent fasting hypertriglyceridemia of 150 – 499 mg/dL after the above steps…

If the patient has persistent fasting hypertriglyceridemia of 150 – 499 mg/dL after the above steps, continue LDL-C-risk-based approach.

  • Rule out secondary causes    |   
  • Further optimize diet and lifestyle    |   
  • May consider icosapent ethyl
  • Shared decision-making, patient preference
  • Clinicians could use a TG risk-based approach once LDL-C levels are optimized and vice versa.
  • TG risk-based approach:
    • Rule out secondary causes    |   
    • Further optimize diet and lifestyle    |   
    • May consider icosapent ethyl
    LDL-C risk-based approach:
  • Continue shared decision-making and patient preference
  • May consider icosapent ethyl

 Steps for lowering Triglycerides:

  • Rule out secondary causes     |    
  • Optimize diet and lifestyle    |   

If the patient has persistent fasting hypertriglyceridemia of 150 – 499 mg/dL after the above steps…

  • Continue to optimize diet and lifestyle   |   
  • Periodic 10-year ASCVD risk assessment
  • Continue shared decision-making, patient preference
  • Consider initiation or intensification of statin therapy
  • Continue shared decision-making, patient preference
  • Initiate or intensify to high-intensity statin therapy

 In-Depth Recommendations for Lifestyle Interventions:

  • Assess non-lifestyle secondary causes   |  
  • Assess lifestyle practices (body weight; diet, including amount and type of carbohydrates, alcohol, and long-chain omega-3 fatty acids; and physical activity)  |  
  • Emphasize healthy dietary pattern* and increased physical activity  |  
  • Monitor response to intervention
  • Consider referral to registered dietician nutritionist, exercise trainer, or other supportive services
  • Continue intervention or adjust as indicated
  • Additional resource: Screening Questions for Assessing Effects of Lifestyle on Triglycerides   |  
  • Additional resource: Clinician Messages to Patients to Encourage Healthy Lifestyle   |  

*Recommendations for a healthy dietary pattern emphasize: vegetables; fruits; legumes; whole grains; nuts; and fish/seafood (other healthy proteins such as low-fat dairy, low-fat poultry); liquid plant-based oils; and replacing saturated fatty acids with monounsaturated fatty acids and polyunsaturated fatty acids. Recommendations also emphasize limiting: red and processed meats; refined carbohydrates; adding sugars (sweets and sugar-sweetened beverages); sodium and dietary cholesterol; and avoiding trans fats.

Inputs


Inputs

  • Age:
  • Triglyceride range: 150 fasted/175 non fasted - 499mg/dL 1.694 fasted/1.976 non fasted - 5.634 mmol/L 500-999 mg/dL 5.645 - 11.279 mmol/L 1000+ mg/dL 11.29+ mmol/L
  • ASCVD?:
  • Diabetes Mellitus?:
  • LDL-C range: <70 mg/dL <1.810 mmol/L 70 - 99 mg/dL 1.810 - 2.56 mmol/L ≥100 mg/dL ≥2.586 mmol/L
  • High risk features:
  • 10-Year ASCVD risk: %,  
  • Sex:
  • Race:
  • Total Cholesterol: mg/dL mmol/L
  • HDL-Cholesterol: mg/dL mmol/L
  • Smoker:
  • Hypertension treatment:

High risk features

  • Men ≥ 55 years
  • Women ≥ 65 years
  • Cigarette smoking or quit smoking within 3 months
  • Hypertension (BP ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic)
  • On hypertension medication
  • HDL ≤ 40 mg/dL (men) or ≤ 50 mg/dL (women)
  • High sensitivity C reactive protein > 3.0 mg/L
  • Renal dysfunction
  • CrCl > 30 and < 60 mL/min
  • Retinopathy
  • Albuminuria (≥ 30 mcg of albumin/mg creatinine)
  • Ankle-brachial index < 0.90 without symptoms of intermittent claudication

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