Considerations for Disadvantaged Patients

From the Clinical Practice Guidelines for the Management of Dyslipidemia by the Philippine Heart Association
This guideline starts below.

Considerations for Disadvantaged Patients

The Philippine Clinical Practice Guidelines on Dyslipidemia consider disadvantaged patients as those with the following characteristics:

• Living below the annual poverty threshold of Php 12,267.00 (as of 2003)
• Cannot afford laboratory examinations and drug therapy
• Have limited or no access to health care
• Are undernourished (e.g., people with BMI less than 18.5)

The following are the general recommendations for disadvantaged patients:

• Regardless of risk and lipid levels, patients should be advised on smoking cessation, weight management, a low-cholesterol diet, correction of nutritional deficiencies, regular physical activity and adequate blood pressure control to reduce overall CV risk.
• No drug therapy is recommended for patients with less than three risk factors and without established atherosclerosis.
• Costs should be considered for patients with greater than 3 risk factors but without established atherosclerosis, as statins may be recommended for primary prevention. Screening with a lipid profile to identify the presence of total cholesterol greater than 190 mg/dL or LDL greater than 100 mg/dL may also be recommended after careful consideration of costs.
• Statins are recommended for patients with diabetes but no established atherosclerosis (if total cholesterol is greater than 190 mg/dL or LDL is greater than 100 mg/dL). Fibrates may be recommended as an alternative to statins (if HDL is less than 35 mg/dL and LDL is less than 90 mg/dL).
• Statins are recommended for patients with established atherosclerosis and total cholesterol greater than 190 mg/dL or LD greater than 100 mg/dL, while fibrates may be recommended as an alternative to statins in patients with HDL less than 35 mg/dL and LDL less than 90 mg/dL.
• Candidates for drug therapy who are chosen on the bases of the above recommendations may be screened using a lipid profile to identify the presence of specific lipid derangements. However, the decision to screen and the method of screening should be made after careful patient education and cost consideration. Patients who choose not to be screened may still be given the option to make an informed choice to initiate statin therapy.
• Monitoring of lipid levels may be recommended. Patients should be provided with proper and adequate information regarding monitoring options to be able to make an informed choice. If patients choose total cholesterol for screening, statin therapy may be initiated at fixed dose. Monitoring may be foregone OR it may also be done using total cholesterol, to be conducted at the soonest after 6 weeks. Dose titration should aim for at least a 20% reduction of total cholesterol from baseline.