Cardio- Hyperlipidemia

Question 1

T/F
HDL has the most impact on Hyperlipidemia.

Answer 1

False
LDL

Question 2

T/F
ACC/AHA Risk Calculator focuses on secondary prevention.

Answer 2

False
PRIMARY prevention prior to having an event.

Question 3

What factors are taken into consideration for the ACC/AHA 10-year ASCVD Risk Score and if ASA is needed?

Answer 3

• Age
• Gender
• Race
• HDL
• BP
• DM
• Smoking

Question 4

What is the 10-yr ASCVD Risk 5-10% gray area

Answer 4

May consider coronary calcium (CAC) testing
- which is scored by points or percentile

Question 5

What is the Coronary Artery Calcium Point Scoring?

Answer 5

> 100-300= significant CV Risk
300= very high risk

Question 6

What is the Coronary Artery Calcium Percentile Scoring?

Answer 6

> 75% add LDL lowering pharmacotherapy (comparing it against the population)

Question 7

Goal LDL for patients with CV events?

Answer 7

LDL < 70 mg/dL

Question 8

High Intensity Examples

Answer 8

• Atherosclerotic CVD
• LDL >190
• DM and CVD 10 year risk >/= 7.5%
  – age 40-75 high intensity
  – ADA LDL < 55 mg/dL
  Note: Age 75 is when you access risk/benefits

Question 9

What are the only 2 high intensity statins and there moderate doses?

Answer 9

• Atorvastatin 40-80 mg (moderate 10-20 mg)
• Rosuvastatin 20-40 mg (moderate 5-10 mg)

Question 10

Why should simvastatin initiation be avoided?

Answer 10

CYP3A4 interactions with amlodipine, amiodarone, diltiazem etc…

Question 11

Which statin has the most POTENT LDL lowering property?

Answer 11

Rosuvastatin

Question 12

What hydrophillic statins may reduce myopathy?

Answer 12

• Pravastatin
• Rosuvastatin
• Fluvastatin

Question 13

PCSK9 Inhibitors injections

Answer 13

alirocumab, evolocumab, and inclisiran
- reduce LDL up to 60-70%

Question 14

Bempedoic acid (Nexletol)

Answer 14

MOA: adenosine-triphosphate citrate lyase (ACL) inhibitor
- Caution in gout patients (increase UA levels)
- tendon risk

Question 15

Zetia

Answer 15

MOA: inhibits gut absorption of cholestrol via Niemann-Pick C-1 Like1 transportor.

GI upset and possible myopathy

Question 16

Medications used to treat TGs?

Answer 16

Fenofibrate
Gemfibrozil
Niacin
Omega-3 Fatty Acids

Question 17

Which TG tx is not at high ASCVD risk and TGs >500

Answer 17

Fenofibrate

Question 18

Which TG tx interacts with statins causing rhabdomyolysis?

Answer 18

Gemfibrozil

Question 19

Which TG tx works well to increase HDL but causes flushing and increase in uric acid?

Answer 19

Niacin

Question 20

Which TG tx interacts has proven efficacy in CV risk reduction?

Answer 20

Omega-3 Fatty Acids (icosapent ethyl)
TG 150- 1,000 mg