4. MTB Step 3 - Lipid Management

Question 1

LIPID MANAGEMENT

1. What is the Single Strongest Indication for Lipid-Lowering therapy with a Statin?

Answer 1

Acute Coronary Syndrome (ACS)

Question 2

LIPID MANAGEMENT

1. What is the Goal of Therapy (eg, LDL level) in those with Coronary Artery Disease (CAD) + Diabetes** or **ACS?
2. When would you answer “Statin Therapy” in a patient with CAD?
3. What 10-year Risk % of CAD would lead you to answer “Statin Therapy” in a patient?

Answer 2

1. LDL < 70 mg/dL
2. LDL > 100 mg/dL
3. 10-year Risk of CAD > 7.5%

Question 3

LIPID MANAGEMENT

What are (5) Risk Factors for Hyperlipidemia?

Answer 3

1. Tobacco use (cigarette smoking)
2. High BP (≥ 140/90 mmHg) or a patient on BP meds
3. Low HDL Cholesterol (< 40 mg/dL)
4. Age:
   
   • Males ≥ 45
   • Females ≥ 55
5. Family Hx of early Coronary Artery Disease:
   
   • Males < 55
   • Females < 65

Question 4

LIPID MANAGEMENT

What is the Most Important reason for using Statins, rather than other medications that also lower LDL, Triglycerides, and Total Cholesterol, and raise HDL (eg, cholestyramine, gemfibrozil, ezetimibe, niacin) the same way Statins do?

Answer 4

Statins have the Greatest Mortality Benefit.

Question 5

LIPID MANAGEMENT

What are (4) Coronary Artery Disease (CAD) equivalents that should get Statin Therapy at ANY Level of LDL?

Answer 5

Disorders that should get a Statin at ANY Level of LDL:

1. Peripheral Artery Disease (PAD)
2. Aortic Disease
3. Carotid Disease
4. Cerebrovascular Disease
5. Coronary Artery Disease (CAD)

Question 6

LIPID MANAGEMENT

What is the Most Common Adverse Effect of Statin medications?

Answer 6

Liver Toxicity

LFTs should be routinely checked

Question 7

LIPID MANAGEMENT

What are (2) PCSK9 Inhibitors and what is their Mechanism of Action (MOA)?

Answer 7

1. Evolocumab
2. Alirocumab

PCSK9 Inhibitors - inhibit Proprotein Convertase Subtilisin Kexin type 9 (PCSK9). PCSK9 blocks the clearance of LDL by the Liver from the Blood.

Question 8

LIPID MANAGEMENT

When would you give a PCSK9 Inhibitor and what is their Route of Administration?

Answer 8

FAMILIAL HYPERCHOLESTEROLEMIA

PCSK9 Inhibitors can bring down Enormously Elevated levels of LDL.

Given SubQ