Cardiovascular Conditions: Dyslipidemia Flashcards
HDL cholesterol
“good cholesterol”
takes cholesterol from blood, moves to liver to be removed
lowers ASCVD risk
Non-HDL cholesterol
includes lipoproteins that contribute to ASCVD
Non-LDL strong predictor of ASCVD
Non-HDL calc = TC - HDL
Triglycerides (TGs)
hypertriglyceridemia associated with ASCVD risk
> 500mg/DL can cause acute pancreatitis
Friedewald equation
LDL = TC - HDL - TG/5
Dont use if TGs > 400
LDL lvls
< 100 = good
> 190 = very high
Non-HDL lvls
< 130 = good
HDL lvls
> 40 men = good
50 women = good
TG lvls
< 150 = good
> 500 = very high
Primary (familial) hypercholesterolemias
genetic defects that cause severe cholesterol elevations
Why isASCVD risk not needed for pts with clinical ASCVD, diabetes or LDL > 190
all should be on statin
Lifestyle changes to help lower cholesterol
limit smoking and drinking
rich in veggies, fruits, whole grains
limt saturated and trans fat, also cholesterol
fish rich in omega 3
exercise 3-4 times a week, at least 40min
Natural products that can help lower LDL
red yeast
OTC fish oils can lower TGs
** garlic no longer considered effective**
Cholesterol lowering drugs should not be used if AST/ALT is….
> 3 times upper limit of normal
Statin indication if secondary prevention ASCVD
High intensity
Statin indication if primary prevention with primary severe dyslipidemia, LDL > 190
High intensity
Statin indication if diabetes, 40-75yrs old and LDL 70-189
High intensity if multiple ASCVD risk factors
Moderate intensity otherwise
Statin indicating if 40-75yrs old, LDL 70-189
ASCVD risk > 20% = high intensity
ASCVD 7.5-19.9% = moderate intensity
High intensity statin and doses
Atorva = 40-80
Rosuvastatin = 20-40
Low intensity statin and doses
Simvastatin = 10
Pravastatin = 10-20
Lovastatin = 20
Fluvastatin = 20-40
Muscle damage from statin
usually within 6 wks of starting
muscle soreness, tiredness or weakness
Rhabdomyolysis is most severe form
Managing myalgias with statins
dont use simvastatin 80mg/day
dont use statin with gemfibrozil
stop statin, retry 2-4 weeks later at lower dose, if still doesnt work then stop and retry in few weeks with another statin
Statin CI
Breastfeeding
Liver Disease
strong CyP3A4 inhib (w/ simvastatin/lovastatin)
Statin warning
Muscle damage
increase CPK/renal failure = inc risk with inc dose/age/using w/ niacin
Dont use during pregnancy
Statin monitoring
Lipid panel 4-12 wk after starting, then usually annually
LFTs at BL then if symptoms
Myalgia = check CPK
Dec urine = check SCr/BUN