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  • 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!

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Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.

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