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7mo
Optimizing Dyslipidemia Management: Strategies for Effective Multidisciplinary Collaboration and ASCVD Risk Reduction

Dyslipidemia refers to abnormal levels of lipids like total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). It is a primary risk factor for atherosclerotic cardiovascular disease (ASCVD), a leading cause of global mortality. Because of its critical role in cardiovascular risk, managing dyslipidemia effectively is vital for preventing adverse outcomes.

A multidisciplinary approach is essential to managing dyslipidemia and reducing ASCVD risk. ASCVD risk factors such as dyslipidemia, diabetes, hypertension, smoking, and a sedentary lifestyle often cluster together, demanding comprehensive and collaborative care. Specialists including cardiologists, endocrinologists, nephrologists, general practitioners, and nutritionists play distinct yet interconnected roles in addressing these risks. For example, cardiologists focus on cardiovascular risk, while endocrinologists manage lipid issues linked to diabetes. General practitioners ensure holistic, continuous care, and nutritionists guide lifestyle modifications foundational to dyslipidemia management.

Multidisciplinary healthcare integrates expertise from various disciplines to optimize patient outcomes. This approach promotes effective communication, shared decision-making, and respect among team members, enhancing both care quality and patient well-being. Key models include interprofessional collaboration, leveraging the unique expertise of each team member to solve problems, as well as team-based care, emphasizing clear roles and a culture of teamwork to ensure coordinated and patient-centered care.

Challenges in multidisciplinary care include coordinating efforts across specialties and maintaining seamless communication. Solutions lie in adopting digital health tools for efficient information sharing, establishing clear care pathways, and fostering a culture of mutual respect among team members.

How do you ensure seamless, patient-centered care when managing dyslipidemia across specialties? What best practices have you found for effective collaboration?

  • 7mo
    Primary prevention of cardiovascular disease is the reponsibility of all specialties but most importantly primary care clinicians In my experice nutritional changes lead to minimal changes in ldl lowering. Medication is the cornerstone and safe. More classes of medictions are available and better accessibility to newer pharmaceutical classes of meds should help with compliance and hopefully reduce risk of future cardiovascular conditions.
  • 7mo
    Since EMRs don't talk well together, we often rely on the patient to let us know who's prescribing what. Communication remains poor between providers.
  • 7mo
    I do believe in lifestyle modification. I encourage patients to eat a healthy diet and to stay physically active. I do start with statins, although many patients are concerned about using them. Fortunately, now we have other options for LDL lowering. Cost can sometimes be an issue with these medication‘s. I like to keep the LDL below 70 and in individuals below 55.
  • 7mo
    Usually one of the specialist or PCP takes charge of managing patient's dyslipidemia. But again input from others and incorporating these input in practice is crucial for better patient outcome
  • 9mo
    with new medications to lower targets can be reach easily than before
  • 9mo
    There needs to be an update to guidelines to help with when to use the newer classes of HLD drugs.
  • 9mo
    Unfortunately, I rarely see seamless care with regard to dyslipidemia. One improvement in this regard would be better insurance coverage of nutritional counseling.
  • 9mo
    In family practice, we are typically starting patients on statins to lower LDL for primary prevention. If a patient then has a cardiac event and/or sees cardiology (and they determine the patient to be high risk) we will typically defer further intensification to them. Once stable, we often take back over lipid management.
  • 9mo
    Achieving LDL target is part of the discussion with the patient during office visits and incorporates behavioral, lifestyle, dietary, physical activity and pharmacologic therapy. With the EMR, when adjusting medications, communication with PCP and other providers has become seamless
  • 9mo
    Communicating with the patient about LDL goals and methods to attain those goals with behavioral, lifestyle, nutritional, physical activity and pharmacologic agents are the cornerstone of management. We have this discussion frequently and with potent medications, achieving LDL is achievable. The EMR allows immediate communication to referring physicians and providers when medicine adjustments are being made.
  • 9mo
    I favor the approach that who is ever in front of the patient, either primary, endo or cardiologist initiate or titrate meds. If there is a complicated case or side effects then there can be commnunication usually with progress notes.
  • 9mo
    with all new cholesterol options to get LDL under 70 for cardiovascular is a loe easier;statins,bempedoic and pck 9 inhibitors,that is no excuse to get ldl at target
  • 9mo
    Firstly, the guidelines are universal language, and making sure people follow them and go for the best outcomes is critical. From there, communicating via the chart, messaging, or old-fashioned phone call is critical to ensure we are all on the same page. Remember the primary goal is NOT LDL -- it is risk reduction first, then LDL goal second.
  • 9mo
    It's an ongoing challenge which requires effective communications between everyone involved in the patient's care. Many times I must rely on the patient to provide information regarding what other clinicians have done. It is helpful that the EMR does report any new medications that are started but does not remove any so it medication list updating is always done at each visit.
  • 9mo
    If LDL is repeatedly over 200 mg/dl especially fasting one must think of familial hypercholesterolemia and a genetic consult is warranted in addition to high dose statin or PCSK9i and low saturated fat diet
  • 9mo
    I agree with the previous comment that having a unified chart, and the ability to communicate via text-like messages in the EMR is crucial to not just learn from each other, but ensure that patients are optimized in terms of their cardiovascular and overall care.
  • 9mo
    As a Physician Assistant in Internal Medicine, collaboration is key. I often will refer to both cardiology and nutrition counseling. Most patients can get to goal with medication, diet and exercise but compliance is important. Cardiology workup is even more necessary for patients with family history of heart disease and/or comorbidities that increase their overall risk.
  • 9mo
    First of all, we have to find a common platform where every specialist can communicate for optimal care. When it more than just medical management for their dyslipidemia as this goes for beyond their medical condition per se. We need to get their nutrition, their lifestyle and their genetics all involved for better overall care. We need to find some kind of dynamic platform, where everyone can share their expertise along with patients their direct involvement for their condition.
  • 9mo
    as a cardiologist, I receive occasional referrals for the sole purpose of treatment of hyperlipidemia, but those are specific cases such as HOFH or severe hypertriglyceridemia. In General referrals are for treatment or diagnosis of heart disease and lipid levels are important risk factors for CAD/PAD if diagnosed. Patients often arrive and are told an LDL <100 if adequate or good, which was prior to clinical diagnosis of CAD. This leads to misunderstandings. Newer guidelines for aggressive lipid lowering should be more publicized. Instead of DTC marketing for specific products, infomercials for aggressive lipid lowering with LDL goal <55 in high risk patients, could be sponsored by Amgen, Novartis, Esperion etc.
  • 10mo
    Education about the new guidelines are very important ( <55 for high risk patients ). That we we can all give patients the same message. It leaves patients confused if one of the team says “cholesterol is great at LDL 68”. And another of us says. Too high at 68. We need to increase your medications.
  • 10mo
    Cardiovascular Risk Reduction is the number one reason to properly manage dyslipidemia. Primary care providers play a key role in identifying and managing dyslipidemia to reduce the risk of these serious health events.
    By controlling lipid levels, providers can help prevent the progression of atherosclerosis, which can reduce morbidity and mortality associated with cardiovascular conditions. Primary care providers are in a unique position to educate patients about lifestyle modifications (such as diet, exercise, and smoking cessation) that can positively impact lipid levels. Empowering patients through education can enhance adherence to treatment plans and promote healthier behaviors. Most national and international health guidelines recommend routine screening and management of dyslipidemia in adults, which underscores its importance in primary care. Primary care providers are essential for ensuring adherence to these guidelines.

    In summary, managing dyslipidemia is important for primary care providers because it is a fundamental aspect of preventing cardiovascular disease, improving patient outcomes, promoting overall health, and adhering to best practices in preventive care.
  • 10mo
    Lipidology is right up to the alley of the Internist/Primary Care both for the primary and secondary prevention and there is hardly an occasion where need to refer to the specialist the only time I need to refer is the one when you have Triglycerides in around 1000 range when not responding to the oral meds and need the plasmapheresis or on occasion Insurance require the PCSK-9 inhibitors need the Cardiologists scripts for it , Otherwise can manage very well on my own as there are well established guidelines to follow in risk stratification and the target farctions of the lipid panel which have become quite simple with Coronary Calclium Score , Lpa and ,apo lipo-B testing , Mangement of the lipids by the primary care also reduces the work load of the cardiologist and they can concenrtate on other testing and interventions as needed at least this is the understanding i have with my referring cardiologist and they defer the Lipid management to our practice ,The management of other risk factors diabetes , obesity and HTN is also our responsibility for optimal control and no need to outsource lipids to specialists when such great meds are available now !!
  • 10mo
    I have practiced Family Medicine for over 35 years. Hyperlipidemia is such an important health issue that it does take a multidisciplinary team. I think it’s helpful for a patient to hear from multiple providers how important it is to get the LDL to goal. I welcome the input from the specialist in this realm, but always keep a very close eye on this medical issue.
  • 10mo
    With some patients getting to ldl-c goal can be a challenge, we can use other tools to help patients outcomes, reduce comorbidities, but compliance is a factor.

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