Understanding the most commonly billed diagnoses in primary care

Hyperlipidemia is a common condition in the United States, affecting an estimated 73.5 million adults. It is characterized by high levels of cholesterol and/or triglycerides in the blood. Hyperlipidemia is a major risk factor for cardiovascular disease, which is the leading cause of death in the United States. There are a number of different types of hyperlipidemia, each with its own unique causes. The most common type of hyperlipidemia is primary hyperlipidemia, which is caused by a combination of genetic and lifestyle factors. Secondary hyperlipidemia is caused by another underlying medical condition, such as diabetes, hypothyroidism, or kidney disease. The treatment for hyperlipidemia typically involves a combination of lifestyle changes and medications. Lifestyle changes that can help to lower cholesterol and triglyceride levels include:

• Eating a healthy diet
• Exercising regularly
• Maintaining a healthy weight
• Quitting smoking

If lifestyle changes are not enough to lower cholesterol and triglyceride levels, medications may be prescribed. There are a number of different types of medications available to treat hyperlipidemia, including statins, bile acid sequestrants, niacin, and fibrates. 2018 Hyperlipidemia Guidelines The 2018 guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that all adults over the age of 20 have their cholesterol and triglyceride levels checked at least once every five years. Adults with other risk factors for cardiovascular disease, such as diabetes, high blood pressure, or smoking, should have their cholesterol and triglyceride levels checked more often. The 2018 guidelines also recommend that all adults with an LDL-C level of 190 mg/dL or higher (≥4.9 mmol/L) start high-intensity statin therapy. Adults with an LDL-C level of 70 mg/dL or higher (≥1.8 mmol/L) and a 10-year ASCVD risk of ≥7.5% should also start statin therapy. The 2018 guidelines also recommend that ezetimibe be added to statin therapy for patients who do not achieve their LDL-C target goal on statin therapy alone. For patients who do not achieve their LDL-C target goal on statin and ezetimibe therapy, a PCSK9 inhibitor may be considered. Implementing the 2018 Hyperlipidemia Guidelines in Primary Care There are a number of things that primary care providers can do to implement the 2018 hyperlipidemia guidelines in their practice. These include:

• Routinely screening all adults for hyperlipidemia
• Starting statin therapy for all adults with an LDL-C level of 190 mg/dL or higher (≥4.9 mmol/L) or an LDL-C level of 70 mg/dL or higher (≥1.8 mmol/L) and a 10-year ASCVD risk of ≥7.5%
• Adding ezetimibe to statin therapy for patients who do not achieve their LDL-C target goal on statin therapy alone
• Considering a PCSK9 inhibitor for patients who do not achieve their LDL-C target goal on statin and ezetimibe therapy

Primary care providers can also educate their patients about the importance of managing their cholesterol and triglyceride levels and the risks of hyperlipidemia. This can be done through individual counseling, group classes, and educational materials. Barriers to the Implementation of the 2018 Hyperlipidemia Guidelines There are a number of barriers to the implementation of the 2018 hyperlipidemia guidelines in primary care. These include:

• Lack of time: Primary care providers are often very busy and may not have enough time to screen all of their patients for hyperlipidemia and manage their cholesterol and triglyceride levels.
• Lack of resources: Primary care practices may not have the resources needed to implement the guidelines, such as cholesterol testing equipment and educational materials.
• Patient adherence: Some patients may not be willing to make the lifestyle changes needed to manage their cholesterol and triglyceride levels. Others may not be able to afford the medications that are needed to treat hyperlipidemia.

Conclusion Hyperlipidemia is a common condition that is a major risk factor for cardiovascular disease. The 2018 hyperlipidemia guidelines from the ACC and AHA provide recommendations for the screening, diagnosis, and treatment of hyperlipidemia in primary care. There are a number of things that primary care providers can do to implement the guidelines in their practice, but there are also some barriers to implementation.  

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