- Dr Paul Dhillon MB BCh CCFP & Dr. Simon Moore MD
Five DON'Ts from CFP's new 2015 lipid guidelines
Some of you might have read all 11 pages of the recent CFP article on Simplified Lipid Guidelines in the Canadian Family Physician but for those of you thinking about the exam coming up and leaving your medical journals safely in plastic we have done the work for you.
Our goal at The Review Course is to give you what we wished we had been given.
So if you are still thinking about the article make sure to read pages 858 and 861. That’s where you'll find the very basics that you need to know for practice and for the exam.
EXAM STUDY TIPS
Remember a key mantra of The Review Course: Management = More than Medication!
It’s easy enough to remember that statin therapy can help in lowering lipids but what if you are asked about other management? Here are three things you can do to improve management for these patients before you even write the prescription:
Optimize modifiable CV risks
Increase exercise to 150 minutes per week
Recommend the Mediterranean diet
Simply writing “Lifestyle changes” on an exam is certainly not the way to go. Next time you catch yourself saying that catch phrase, take a moment to write out exactly what you mean!
PEARLS FOR PRACTICE
The Simplified Lipid Guidelines have a number of DON'Ts. Here are a few:
DON'T test lipids frequently or treat to LDL targets! The Simplified Lipid Guidelines recommend testing lipids every 5 years in patients who are not on lipid-lowering therapy (moderate-quality evidence) - not more frequently as you may have been taught. RCTs have never shown that treating to lipid targets significantly benefit cardiovascular events.
DON'T use Framingham in CKD! As well, remember Framingham has its limits; it doesn't modify risk for patients with CKD, who have significantly increased cardiovascular disease risk. If your patient has chronic kidney disease, consider using a risk calculator like the QRISK2 which takes this in to account (as well as RA and A. Fib.).
DON'T make your patients fast! When it comes to risk calculation, the same information can be obtained from a non-fasting lipid panel.
DON'T order Apo-B or CRP! These "do not add meaningfully to risk reduction."
DON'T use Ezetimibe for primary prevention! The benefit of this is only 1% for high-risk patients, and even less for low-risk patients.
Finally, a bonus DON'T: Don't forget that you can submit for Mainpro M1 credits not only for reading the above article but for reading the journals that you receive in the post every month. I just keep a list of the journals that I read and then submit my reading time in a block after FMF when I review to make sure all my credits are in place online. The more Mainpro you save up in Residency the better, and it’s cheaper than when you are in practice to attend FMF!