Cardiology_Lipid Lowering Flashcards
When hypercholesterolemia is identified, what further laboratory workup is indicated?
- Fasting blood glucose
- TSH
- liver function tests (LFTs)
- creatinine
The primary target of cholesterol lowering therapy is low-density lipoprotein (LDL). How is the LDL goal established?
- By determining the patient’s risk of having a coronary heart disease (CHD) event sometime in the next 10 years
List CHD risk factors.
- HTN
- high-density lipoprotein (HDL) <40 mg/dL
- smoking, male >45 years old
- female >55 years old
- family history of early CHD
- first-degree male with CHD <55 years old
- first-degree female with CHD <65 years old)
What HDL level is considered a negative risk factor and may be counted as a “minus one” toward the overall number of CHD risk factors?
- HDL >60 mg/dL
What lifestyle modifications can increase HDL?
- Increased aerobic activity and moderate alcohol consumption (1-2 drinks per day)
List CHD equivalents.
- Diabetes mellitus
- Peripheral artery disease
- Any combination of risk factors leading to a cumulative 10-year CHD risk of over 20% - as determined by a risk calculator
- Symptomatic carotid artery disease
- Abdominal aortic aneurysm
Someone with known CHD or a CHD equivalent has a ___% risk of having another CHD event event sometime in the next 10 years.
> 20
What lifestyle modifications can lower LDL?
- Dietary modifications
- Increased physical activity
- Smoking cessation
- Weight loss
LDL treatment guidelines
To lower cholesterol levels, what dietary modifications should be made in regards to fat intake?
- Total dietary fat should be less than 35% of total caloric intake (<10% polyunsaturated fat, <7% saturated fat).
- Cholesterol intake less than 200 mg/day.
What is the LDL goal for patients with CHD or a CHD equivalent?
- LDL <100 mg/dL
What is the LDL goal for patients with 0-1 risk factor(s) and no CHD or a CHD equivalent?
- LDL <160 mg/dL
LDL <70 is an optional goal for which subset of patients?
- Very high-risk patients
- recent myocardial infarction
- metabolic syndrome
- CVD with diabetes or severe or poorly controlled risk factors such as smoking
How long after initial lifestyle modifications and/or medical therapy is started should lipids be rechecked?
6 weeks
What class of drugs represents the current first line pharmacotherapy in the lowering of LDL?
Statins
What is the mechanism of action of statins?
- Inhibit HMG-CoA reductase (enzyme in the pathway that produces cholesterol)
Statins lower LDL levels by what percentage?
20%-40%
Statins increase HDL by what percentage?
- 5%-15%
What are the major contraindications to statin use?
- Acute or chronic liver disease
- concomitant use of certain drugs (eg, macrolides, alcohol)
- history of serious adverse effects with statins (eg, rhabdomyolysis)
What percentage of patients on statins will experience by myalgias as a side effect?
5%
What fat-soluble substance found in some foods (highest in meat and fish) that is also available as a vitamin supplement may be used to reduce myalgia symptoms in many patients?
- Coenzyme Q10 (ubiquinone): 100 mg PO daily as a supplement dose
What percentage of patients on a statin will develop rhabdomyolysis?
- 0.1%
What are the symptoms of rhabdomyolysis (should prompt patient to stop statin immediately)?
- Severe myalgias
- muscle weakness
- dark urine
What are the risk factors for statin-induced myopathy?
- Concurrent use of a fibric acid derivative (especially gemfibrozil)
- older age
- female gender
- low weight
- acute physical stress
