Cardiovascular Risk Reduction: Lipids Flashcards
True or false: there is no evidence to support treating to a specific LDL or HDL target.
true
What are the four statin benefit groups? (people who benefit from statins)
- people with clinical CV disease
- People with LDL over 190
- People 40-75 yo with diabetes (even with normal LDL and no CV disease)
- People who have an estimated 10 yr CV disease risk over 7.5% (even without clinical CV disease or diabetes)
High intensity statin therapy will reduce LDL on average by what percent?
greater or equal to 50%
Moderate intensity statin therapy will reduce LDL by what?
30-50%
Low intensity statin therapy will reduce LDL by what?
less than 30%
What are the two high-intensity statin regimens?
Atorvastatin 40-80 mg
Rosuvastatin 20-40mg
What are some secondary causes of hyperipidemia?
diet (and alcohol)
drugs: diuretics, cyclosporine, steroids, amiodarone, estrogens, beta blockers, thiazides
biliary obstruction, nephrotic syndrome, chronic renal failure
hypothyroidism, pregnancy
What are the factors that go into calculating the CV risk status?
age, gender, blood pressure, diabetes, hypertension (treated or not) and smoking
In patients with diabetes, what intensity of statin therapy should you use?
moderate is recommended, but you should consider high-intensity if their CV disease risk is over 7.5%
In benefit group 4 (CV risk over 7.5% but no diabetes and normal ldl), what intensity of statin therapy should you use?
moderate or high
How often should you estimate someone’s CV risk if they’re not on a statin?
every 4-6 years
What are some patient characteristics that would make you think a patient may not be able to tolerate a high-intensity statin?
- medical comorbidities like liver and renal disease
- baseline ALT > 3x normal
- Age over 75
- on interacting drugs
- hx hemorrhagic stroke (IDK why)
- Asian ancestry (I assume it’s a metabolism thing)
What is the most complicated problem of statin safety?
myopathy (ranges from myalgia to rhabdomyolysis and renal failure)
Because of the risk of myopathy, should you routinely check a baseline CK?
no, but consider if they’re at risk for muscle disease (family hx of statin intolerance or muscle disease)
So when should you measure a CK then?
if they have symptoms develop (pain, stiffness, cramping, fatigue)
If the symptoms are mild to moderate, what other causes should you consider?
hypothyroid PMR steroid myopathy Vit D deficiency primary muscle disease
True or false: if someone has a statin intolerance, you should never use the same statin again.
false - after symptoms resolve, you should rechallenge with the original or lower dose of the same statin to establish causality
then is symptoms recur, you should change to a different statin at a low dose
You should get a baseline ALT before starting a statin, but do you need to routinely check it?
nope - not recommended unless the patient has symptoms suggesting hepatotoxicity (fatigue, loss of appetite, abdominal pain, dark urine, jaundice)
True or false: statin use has been associated with a modest excess risk of new-onset diabetes in RCTs and meta-analyses.
true
but it’s confined to those with other risk factors
ultimately the small risk of DM outweight the potential ASCVD risk reduction
True or false: there is evidence for memory impairment/confusion with statin use.
false - no proven link
What are the three pharmacologic categories you can use in patients who can’t take a statin or didn’t respond adequately to a statin?
ezetimibe
bile acid sequestrants
PCSK-9 inhibitors
How does ezetimibe work?
it modifies cholesterol absorption in small intestine
Bile acid sequestrants can have an added benefit in what patient population?
diabetics
coleselavan has been shown to lower A1c by 0.5%
What are the limiting factors for bile acid sequestrants
GI side effects and pill burden
How do the PCSK-9 inhibitors work?
they’re monoclonal antibodies against PCSK-9, which increases LDL receptors/clearance
What is the main drawback for the PCSK-9 inhibitors?
cost (13K/yr)
