10/29 Flashcards
people in the US w high cholesterol
men age 45-54: 20.8%
women age 55-64: 30.5%
all women: 16.9%
lipoprotein abnormalities can contribute to…
increased risk of coronary, cerebrovascular and peripheral arterial disease
-major risk factor for CHD
pathogenesis of atherosclerosis
endothelial injury -> inflammatory response -> macrophage infiltration -> platelet adhesion -> smooth muscle cell proliferation -> extracellular matrix accumulation
secondary causes of dyslipidemia
elevated LDL: hypothyroidism, nephrotic syndrome, cholestasis, anorexia, thiazides, cyclosporine, tegrtol
reduced LDL: severe liver disease, malabsorption, mal nutrition, hyperthyroidism, niacin toxicity
elevated HDL: alcohol, exercise, exposure to chlorinated hydrocarbons, estrogen
reduced HDL: smoking, T2DM, obesity, malnutrition, steroids, BB
symptoms of dyslipidemia
largely asymptomatic
depending on severity and duration of disease:
-chest pain, palpations, sweating, anxiety, SOB, loss of consciousness, difficulty w speech or movement, abdominal pain, sudden death
signs of dyslipidemia
pancreatitis, eruptive xanthomas, peripheral polyneuropathy, inc BP, waist >40 in men or >35 in women, BMI > 30kg/m2
lab parameters associated w dyslipidemia
inc: non-HDL-C, TC, LDL-C (amount of cholesterol in LDL), TG, Apo-B, CRP, LDL-P (number of LDL particles)
dec: HDL
non-HDL-C =
TC-HDL
ApoB, LDL-P, and non-HDL-C
all valid in non-fasting sample and w elevated TG levels
all more predictive of CVD risk than LDL-C alone
FLP includes
TC, TG, HDL-C, LDL-C
friedewald equation
used to estimate LDL from FLP
LDL calc not valid when TG > 400 mg/dL
LDL = TC - HDL - TG/5
non-fasting FLP
TC and HDL
lifestyle management
DASH diet, USDA food pattern, AHA diet: vegetables, fruits, whole grains, low fat dairy, poultry, fish, legumes, non-tropical vegetable oils and nuts, limit sweets and red meats
reduce percent of calories from saturated and trans fat: 5-6% calories from sat fat
lower NA intake: less than 2400 mg
moderate intensity exercise 3-4x/week for 40 min/session
TC/HDL
goal: less than 5:1 (or 3-3.5:1)
soluble fiber will ___
decreased LDL
-oat bran, petins or gums, psyllium products
recommended dietary intake
total fat: 25-35% of calories saturated fat: less than 7-10% total calories carbs: 50-60% total calories cholesterol: less than 200 mg/day fiber: 20-30 grams/day plant sterols: 2 grams/day protein: 15% of total calories
effects of pharmacologic agents on serum LDL
statins: reduce 20-60%
BARs: reduce 15-30%
niacin: reduce 10-25%
cholesterol absorption inhibitor: reduce 17%
effects of pharmacologic agents of serum TGs
gemfibrozil: reduce 35-50%
fenofibrate: reduce 41-53%
omega 3 fatty acids: reduce 23-45%
HMG-CoA reductase inhibitors
lovastatin, pravastatin, pitavastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin
statins: important consideration
usually well tolerated, DC if LFTs 3x upper limit of normal, myopathy, rhabdomyolysis, watch for muscle pain and darkened urine, avoid large quantities of grapefruit juice, PREGNANCY CATEGORY X
statins can cause ___ and ___
hyperglycemia and cognitive decline
statin monitoring
FLP: baseline, 4-12 weeks after initiation, every 3-12 months as indicated
consider: baseline CK in pts with increased risk of muscle events, CK while on therapy of patients with muscle symptoms, hepatic function in individual w s/sx of hepatatoxicity
BARs
bile acid resins
cholestyramine, colestipol, colesevelam
BARs overview
decrease LDLs and cholesterol
disadvantages: may increase TGs, need to take other meds 1 hour before or 4 hours after
GI SE
AE: impaired absorption of ADEK, hypernatremia, hyperchloremia, GI obstruction
BARs interactions
may decrease effect of: acetaminophen, TZDs, OCs, CSs, ezetimibe, fibrates, thiazide diuretics, warfarin, digoxin
niacin
OTC
PG mediated flushing and itching: administer ASA 30 minutes before niacin, take close to meals, avoid alcohol and hot drinks, start w low dose and titrate, inc LFTs, hyperuricemia and hyperglycemia, may inc levels of statins