Endocrine diseases possess a greater cardiovascular risk for patients. Endocrine Society has updated the clinical practice guidelines. Endocrine diseases include diabetes, Addison's disease, cystic fibrosis, thyroid disorders - hypothyroidism & hyperthyroidism, etc.
The new guidelines recommend checking the lipid profile of patients with endocrine disorders so that cardiovascular risk can be calculated. Many of the endocrine disorders exacerbate dyslipidemia (elevated cholesterol or lipids in the blood) and may increase triglycerides to a greater extent.
Usually, the focus is on treatment and assessment of endocrine disorders, but it is also important to assess the atherosclerotic (build-up of fats, cholesterol, and other substances in and on the artery walls) cardiovascular disease risk and treat it appropriately.
All endocrine disorders carry a host of cardiovascular risk factors that require strict and careful monitoring. The recent guidelines suggest adding EPA (eicosapentaenoic acid ethyl ester) in adults with endocrine disorders to reduce the risk of cardiovascular disorders. In many patients, it is observed that if the underlying endocrine disorder is treated appropriately, dyslipidemia is resolved automatically.
The guidelines published in the Journal Of Clinical Endocrinology & Metabolism mention about the risk factors and evidence based recommendations for management & treatment. The key recommendations are as follows:
- Obtain a lipid profile panel and evaluate the cardiovascular risk factors in all adults with endocrine disease.
- Patients with type II diabetes & possessing risk factors for cardiovascular disease should be started on statin therapy (lipid lowering agent). The patients should also be advised lifestyle modifications so as to reduce cardiovascular risk.
- Patients with hyperlipidemia (abnormally high concentration of fats or lipids in the blood), should be prescribed a thyroid profile so that hypothyroidism can be ruled out. If hypothyroidism is ruled out the patients should be started on a lipid lowering agent. If the thyroid profile suggests hypothyroidism then the lipid profile should be revaluated when the levels of the thyroid hormone of the patients are back in the normal range.
- Patients with endogenous Cushing's Syndrome should have their lipid profile monitored regularly. Statin (lipid lowering agent) therapy to be started & patients must be advised lifestyle modifications, irrespective of the cardiovascular risk score.
- In post-menopausal women the high cholesterol levels should be treated with statins rather than hormone therapy.