37 - Dyslipidemias Flashcards
Who and how often should we screen for dyslipidemias?
- those with fam Hx
- those over 40
- women who are postmenopausal
screen every 3 years
What is the Fridewald equation?
LDL-C = Total-C - (HDL-C + TG/2.2)
*cannot be used if TG > 4.52
Is fasting before test required?
no longer required unless TG > 4.5
What are some optional targets after reaching LDL-C goals?
non-HDL-C < 2.6 mmol/L
apolipoprotein B < 0.8 g/L
What are very high TGs (>10 mmol/L) are risk factor for?
pancreatitis
Non-pharms
- diet (aimed at decreasing blood levels of lipids and weight if needed)
- For primary prevention, try diet x 3 months
- For secondary prevention or high risk patients, initiate cholesterol-lowering med at the same time as dietary changes
- eat sterol enriched foods (margarine, fruit juice)
- other lifestyle mods to reduce risk of CVD (smoking cessation, stress management, weight loss, physical activity)
What is 1st line?
Statins bc they have established CV benefit
s/e of statins
- muscle-related symptoms
- concern with new onset DM
- anecdotal reports of memory loss
cholesterol absorption inhibitor: example?
ezetimibe
What is Ezetimibe (cholesterol absorption inhibitor) indicated for?
monotherapy or in combo with statins
Ezetimibe is better tolerated than ____
resins (ex. cholestyramine)
Does ezetimibe improve CV outcomes
no - not been proven to
Give examples of fibrates
- gemfibrozil
- bezafibrate
- fenofibrate
How do fibrates work?
- lower TG
- raise HDL-C
may benefit patients with diabetic dyslipidemias
*effect of fibrates on LDL-C is variable
Which fibrates lower LDL-C more consistently and can be combined with a statin?
- Benzafibrate
- Fenofibrate
Give an example of a microsomal triglyceride transfer protein inhibitor
Lopitamide
What is lopitamide indicated for?
as adjunctive Tx in adult homozygous familial hypercholesterolemia
What can Lopitamide cause?
hepatic toxicity, therefore need to monitor hepatic transaminases
What is nicotinic acid (niacin)?
What does it do?
a B vitamin that at high doses lowers TG and LDL-C and raises HDL-C more than any other lipid-lowering agent
*also lowers lipoprotein (a)
What types of forms of niacin is more hepatotoxic?
slow-release forms more hepatotoxic than IR forms
What are examples of PCSK9 inhibitors?
alirocumab and evolocumab
What do PCSK9 inhibitors do?
- they are SC injection
- result in substantial LDL-C reduction beyond that achieved with statins alone
Give 3 examples of Bile acid sequestering resins
- Cholestyramine
- Colesevelam
- Colestipol
Resins help improve ___ outcomes when used alone
CV
What are the main drawbacks to using resins?
- GI distress
- concomitant drug malabsorption
T or F: Resins are appropriate for children, pregnancy and breastfeeding
true
Ezetimibe can be used in kids ___ and older
10
Non-Rx Agents:
How much psyllium do you need to lower LDL-C?
daily consumption of 10 g psyllium can decrease LDL-C by 7%
Non-Rx Agents:
Is omega-3 FA recommended?
it is recommended (1 g/day) but no evidence to improve CV outcomes
Non-Rx Agents:
Patients taking 2-4 g of O3FA decrease TG by ____%
25-30%
Non-Rx Agents:
If they take >3g/day of O3FA they need to do so under Dr.’s supervision as this can increase risk of ____
bleeds
Pregnancy:
d/c all lipid-lowering agents except _____
resins
Pregnancy:
If resins are tolerable, what should you initiate?
a lipid-soluble vitamin supplement
Pregnancy:
Is it a big deal to stop all lipid-lowering agents for duration of therapy?
No - interrupting lipid-lowering Tx during childbearing potential has little impact on overall risk
Breastfeeding:
Which drugs are recommended?
NONE
don’t use these drugs while breastfeeding, begin lipid-lowering agent again after breastfeeding completed
Doubling the dose of a statin will further reduce the LDL-C level by only ___%
6%
Appears to be safe to target LDL-C levels to _____ in individuals with overt CHD and multiple risk factors
1.3 mmol/L
