Risk factors

Lipid and CVD risk screening needed for all patients with endocrine diseases

New guidelines from the Endocrine Society address the information gap regarding dyslipidemia screening and cardiovascular risk assessment and management in endocrine diseases beyond diabetes and obesity.

The guidelines, published in The Journal of Clinical Endocrinology & Metabolism, also provide recommendations on lipid management in thyroid disease, Cushing’s syndrome, disorders of growth hormone secretion, PCOS, menopause, hypogonadism, hormone replacement in men and women, and gender-affirming hormone therapy.

Their aim is to help prevent cardiovascular events and triglyceride-induced pancreatitis.

Chair of the guideline committee Adjunct Professor Connie Newman, from the New York University Grossman School of Medicine, said the guideline was the first of its kind.

“We hope that it will make a lipid panel and cardiovascular risk evaluation routine in adults with endocrine diseases and cause a greater focus on therapies to reduce heart disease and stroke,” she said in a statement.

The recommendations, based on two systematic reviews and covering lifestyle interventions, pharmacologic interventions, and bariatric surgery, include:

  • Obtain a lipid panel and evaluate cardiovascular risk factors in adults with endocrine disorders.
  • Start statins earlier in patients with type 2 diabetes and risk factors for cardiovascular disease.
  • Consider statin therapy at a younger age in adults with type 1 diabetes who have obesity, or vascular complications, or a 20-year history of diabetes.
  • Rule out hypothyroidism before treatment with lipid-lowering medications. In patients with hypothyroidism, re-evaluate the lipid profile when the patient has thyroid hormone levels in the normal range.
  • Monitor the lipid profile in adults with Cushing’s syndrome and consider statin therapy in addition to lifestyle modifications if Cushing’s syndrome persists after treatment.
  • To treat high cholesterol or triglycerides in post-menopausal women, use statins rather than hormone therapy.
  • Evaluate and treat lipids and other cardiovascular risk factors in women who enter menopause early (before the age of 40-45 years).

The guidelines note the importance of a shared decision-making process regarding the individualisation of preventive therapies.

“For example, a general discussion of lifetime ASCVD risk, and accordingly, lifetime treatment benefit, may be an important part of the clinician–patient risk discussion in younger adults,” they said.

“When a patient is unwilling or unable to take medication or prefers taking preventive medication at any level of risk, there is little value in advanced risk stratification beyond the standard traditional risk factor assessment.”

The guidelines also provide a comprehensive summary of the safety of lipid-lowering medications.

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