title: Monitoring of lipids, enzymes, and creatine kinase in patients on lipid-lowering drug therapy.
abstract: A number of plasma lipid parameters have been used to estimate cardiovascular risk and to be targets for treatment to reduce risk. Most risk algorithms are based on total cholesterol (T-C) or low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), and most intervention trials have targeted the LDL-C levels. Emerging measures, which in some cases may be better for risk calculation and as alternative treatment targets, are apolipoprotein B and non-HDL-C. Other lipid measures that may contribute in risk analysis are triglycerides (TG), lipoprotein(a), and lipoprotein-associated phospholipase A2. The primary treatment target in cardiovascular prevention is LDL-C, and potential alternative targets are apoB and non-HDL-C. In selected individuals at high cardiovascular (CV) risk, TG should be targeted, but HDL-C, Lp(a), and ratios such as LDL-C/HDL-C or apoB/apoAI are not recommended as treatment targets. Lipids should be monitored during titration to targets. Thereafter, lipids should be checked at least once a year or more frequently to improve treatment adherence if indicated. Monitoring of muscle and liver enzymes should be done before the start of treatment. In stable conditions during treatment, the focus should be on clinical symptoms that may alert muscle or liver complications. Routine measurement of CK or ALT is not necessary during treatment with statins.
authors.affiliation: Wallenberg Laboratory, Department of Experimental and Clinical Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden. Wiklund@wlab.gu.se
authors.forename: Olov
authors.initials: O
authors.lastname: Wiklund
authors.forename: Carlo
authors.initials: C
authors.lastname: Pirazzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Romeo
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D004796:Clinical Enzyme Tests / Q000379:methods; D003402:Creatine Kinase / Q000097:blood*; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood*; D018570:Risk Assessment / Q000379:methods
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids; D003402:Creatine Kinase