What are the NHLBI guidelines on the treatment of type II hyperlipoproteinemia (HLP)?

Updated: Jun 27, 2019
  • Author: Henry J Rohrs, III, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend medical therapy based on family history and risk factors. Positive family history includes myocardial infarction, angina, coronary artery bypass graft/stent/angioplasty, sudden cardiac death in a parent, grandparent, aunt, or uncle that is less than 55 years for males and less than 65 years for females. The risk factors are divided into high and moderate levels. [19]

High-level risk factors include the following [19] :

  • Hypertension that requires drug therapy

  • Cigarette smoking

  • Body mass index (BMI) ≥97th percentile

  • Presence of high-risk condition, such as type 1 diabetes mellitus, type 2 diabetes mellitus, chronic kidney disease, end-stage renal disease, post renal transplant, orthotopic heart transplant, or Kawasaki disease with current aneurysms

Moderate-level risk factors include the following [19] :

  • Hypertension that does not require drug therapy

  • BMI ≥95th percentile, but < 97th percentile

  • HDL-C < 40 mg/dL

  • Presence of a moderate-risk condition, such as Kawasaki disease with regressed coronary aneurysms, chronic inflammatory disease, human immunodeficiency virus (HIV) infection, or nephrotic syndrome

If following the CHILD-2 LDL-lowering recommendations does not reduce the patient's LDL-C to less than 130 mg/dL after 6 months, the following additional recommendations are made [19] :

  • LDL-C ≥190 mg/dL: Initiate statin therapy

  • LDL-C ≥160-189 mg/dL with positive family history or one high-level risk factor or two or more moderate-level risk factors: Initiate statin therapy

  • LDL-C ≥130-159 mg/dL with two high-level risk factors or one high-level risk factor and two or more moderate-level risk factors or clinical cardiovascular disease: Initiate statin therapy

  • LDL-C ≥130-189 mg/dL with negative family history and no other risk factors: Continue the CHILD-2 LDL diet; follow every 6 months with a fasting lipid profile


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