Scope and Target Population:
This guideline describes the treatment of adults age 20 and older who are dyslipidemic.

Clinical Highlights and Recommendations:

• Initiate a statin in patients who have a history of CHD or CHD equivalent.
  
• There is no upper age cutoff for management of lipids.
  
• Establish lipid goals based on risk level.
  
• Instruct patients on healthy lifestyle and adjunctive measures.
  
• Patient adherence with recommended therapy should be reinforced during scheduled follow-up.
  
• Folic acid and vitamin B are not recommended for treatment of hyperhomocysteinemia or prevention of CAD.
  
• LDL goal less than 70 is recommended for patient with established CAD, non-cardiac artherosclerosis or coronary artery disease equivalent (i.e., diabetes mellitus).

Priority Aims:

1. Increase the percentage of patients whose 10-year risk is greater than 20% or with known CHD or CHD equivalent who achieved LDL goals.
   
2. Improve the percentage of patients without known CHD or CHD equivalent with lipid disorders who meet their treatment goal.
   
3. Increase adherence with adjunctive treatment of patients with CHD or CHD equivalent through education. (See floating box 3-6 on algorithm page)
   
4. Improve the percentage of patients on lipid-lowering medication who receive regular follow-up care for lipid disorder.
   
5. Increase the percent of patients on lipid-lowering therapy who remain on therapy.

Additional Background:
The guideline is a natural follow-up to the ICSI Preventive Services for Adults Guideline. Management of lipid disorder in adults is an area of practice variability among providers. The condition is relatively common in the adult population and treatment costs can be significant. The guideline incorporates recommendations from the National Cholesterol Education Program (NCEP-ATP III) and research studies which include: the Framingham Study, WOSCOPS, TexCAPS, 4S, Helsinki Heart Study, HITS Trial, The LIPID Study, and HERS.