Guideline: Measure lipids for all adults with endocrine conditions
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All adults with endocrine disorders should undergo measurement of cholesterol and triglyceride levels to better manage their cardiovascular risk, according to a new clinical practice guideline from the Endocrine Society.
“Hormones modulate pathways of lipid metabolism, and therefore it is not surprising that some endocrine diseases are associated with high cholesterol and/or high triglycerides, and sometimes low levels of HDL cholesterol,” Connie B. Newman, MD, FACP, FAHA, FAMWA, an adjunct professor of medicine in the division of endocrinology, diabetes and metabolism at New York University Grossman School of Medicine, New York, told Healio. “However, with the exception of diabetes, endocrine diseases are not discussed in cholesterol management guidelines. We wrote this guideline because we wanted to communicate the importance of measuring a lipid panel and assessing cardiovascular risk in people with endocrine disorders.”
The guideline, published online in the Journal of Clinical Endocrinology & Metabolism, describes the lipid profile and risk for atherosclerotic CVD in adults with endocrine disorders and evaluates the degree to which treatment of the endocrine disorder improves the lipid abnormalities, Newman said.
“For example, in people with hypothyroidism, LDL cholesterol levels can be elevated, but with thyroid hormone treatment, LDL cholesterol levels decrease markedly,” said Newman, who also served as chair of the lipid guideline committee. “Various endocrine disorders increase risk for atherosclerotic CVD, including Cushing’s syndrome, Cushing’s disease, high-dose chronic glucocorticoid therapy, and possibly adult growth hormone deficiency and acromegaly.”
The guideline outlines management recommendations for endocrine-specific conditions:
- Obtain a lipid panel and evaluate CV risk factors for all adults with endocrine disorders.
- In adults with type 2 diabetes and CV risk factors, initiate statin therapy early.
- Consider statin therapy at a younger age for adults with type 1 diabetes who have obesity, vascular complications or a disease duration of 20 years or more.
- Rule out hypothyroidism before treatment with lipid-lowering medications. For adults with hypothyroidism, reevaluate the lipid profile when thyroid hormone levels are in the normal range.
- Monitor the lipid profile for 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 postmenopausal women, use statins rather than hormone therapy.
- Evaluate and treat lipids and other CV risk factors for women who enter menopause early, defined as menopause before age 45 years.
“Elevated LDL cholesterol can lead to atherosclerosis in the coronary, cerebral and peripheral arteries, and very high levels of triglycerides may lead to pancreatitis,” Newman said. “Medications such as statins, in conjunction with diet and exercise, reduce LDL cholesterol levels and reduce the risk for CVD. High triglyceride levels can be treated with diet and avoidance of medications that raise triglycerides; however, in some cases, triglyceride-lowering medications may also be needed.”
Newman said it is important to address CV risk early to prevent accumulation of atherosclerotic plaque in arteries.
“The longer the exposure to high levels of LDL cholesterol, the greater the atherosclerotic plaque, and the higher the risk for a CV event such as myocardial infarction,” Newman said.
For more information:
Connie B. Newman, MD, can be reached at connie.newman@nyulangone.org; Twitter: @ConniesMedicine.
Perspective
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Scott D. Isaacs, MD, FACE, FACP
This clinical practice guideline provides specific guidance for managing dyslipidemia and reducing cardiovascular risk in patients with both common and rare endocrine disorders that have not been covered by other guidelines.
Because patients with endocrine disorders are at very high risk for CVD, all endocrine patients should be screened for dyslipidemia with a lipid panel and enhanced lipid testing, such as lipoprotein(a) and apolipoprotein B, and coronary artery calcification scoring for risk stratification for the highest risk patients.
The guideline offers perspective on the connection between endocrine health and CV health, addressing endocrine disorders not thoroughly covered in other guidelines, such as in type 1 diabetes, thyroid disorders, Cushing’s syndrome, adult GH deficiency and acromegaly, as well lipid management for hormone-treated conditions, such as chronic glucocorticoid therapy, menopausal hormone replacement, male hypogonadism, anabolic steroid abuse and gender-affirming HT.
Adults with common endocrine disorders, such as diabetes, obesity, polycystic ovary syndrome and metabolic syndrome, are at very high risk for CVD. This guideline echoes the guidance in the 2020 American Association of Clinical Endocrinology dyslipidemia algorithm, with an aggressive approach to LDL lowering and triglyceride management for high-risk patients.
Endocrine disorders such as Cushing’s syndrome, adult GH deficiency, acromegaly and untreated hypothyroidism are considered “risk-enhancing factors,” which add to traditional CV risk factors.
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