25

Question 1

describe the difference between High density and low density cholesterol

Answer 1

• High Density = secure, efficient transport (HDL-C)
• Low density = Insecure, inefficient transport (LDL-C)

Question 2

describe triglycerides

Answer 2

• calorie transport to and from liver
• glycerol with 3 long chain fatty acids
• linked to obesity and atherosclerosis
• generally inversely proportional to HDL-C

Question 3

define lipid hypothesis

Answer 3

• LDL-C levels directly relate to ASCVD risk

–> prior: total cholesterol

–> LDL-C

Question 4

define coronary atherosclerosis

Answer 4

• Presence of raised, yellow, flat plaques in t he endothelial layer of this aorta from the middle-aged man
• significantly decreased lumen size

Question 5

define pooled cohort risk assessment

Answer 5

• Estimates 10 year risk for Coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke

Question 6

what are major cardiovscular risk factors

Answer 6

• Cigarette smoking
• hypertension
• diabetes mellitus
• family history of premature CAD
• Age

Question 7

What are the risk equivalents

Answer 7

• Risk of ASCVD “hard” event = having CAD

–> Diabetes mellitus

–> known ascvd: PAD, AAA, CVA

–> chronic renal disease

Question 8

describe 4 major statin benefit gorup

Answer 8

• Secondary prevention = ALL INDIVIDUALS with clinical CVD
• Primary prevention

–> isolated LDL-C (above 190)

–> diabetes mellitis, 40-75years, LDL (70-189)

–> 10 year CVD risk, age 40-75 years and LDL of 70-189

Question 9

what are some non-drug LDL-lowing therapy

Answer 9

• EDUCATION
• increase physical activity
• weight control
• dietary modification (reduce intake of saturated fat and cholesterol)
• control of other ASCVD risk factors

Question 10

describe HMG CoA reductase inhibitors

Answer 10

• DECREASE LDL and TG
• increas HDL
• SIDE EFFECTS = myopathy, increase liver enzymes
• AVOID in liver disease and high grades of HF

Question 11

describe the demostrated therapeutic benefits of statins

Answer 11

• Reduce

–> major coronary events

–> CAD mortality

–> coronary procedures

–> stroke

–> total mortality

Question 12

describe bile acid sequestrants

Answer 12

• Actions:

–> reduce LDL

–> INCrease HDL and TG

• Side effects = gi distress/constipation (decrease absorption of other drugs)
• Contraindicated: dysbetalipoproteinemia and Raised TG
• THERAPEUTIC BENEFIT = Reduce major coronary events, and CAD mortility

Question 13

describe nicotinic acid

Answer 13

• Actions

–> lowers LDL and TG

–> raises HDL

• Side effects: flushing, hyperglycemia, hepatotoxicity (
• Aspirin blocks some side effects
• Contraindicated in liver disease, severe gout, peptic ulcers
• THERAPEUTIC BENEFITS = reduce major coronary events without statins

–> NO REDUCTION IN TOTAL MORTALITY

Question 14

Fibric acids

Answer 14

• Major actions

–> Lower LDL, TG

–> raise HDL

• Side effects = dyspepsia, gallstones, myopathy
• Contraindicated = severe renal or hepatic disease
• Thereapeutic benefit: reduce progression of coronary lesions, reduce major coronary events

Question 15

PCSK9 INhibitors

Answer 15

• Proprotien convertase subtilisin kexin type 9
• DECREASE LDL by 36-59%
• TX of familial hypercholesteremia

(genetic variant which DECREASES LIVER LDL RECEPTORS (less LDL is removed from circualtion)

Question 16

describe teh choice of tx

Answer 16

• Statins are teh drugs of choice for dyslipidemias
• Intensity of therapy parallels RISK more than Lipid levels (patient oriented medicine)