CCS Dyslipidemia 2021 Guidelines + FH

Question 1

Who to screen regardless of risk factors (Based on sex and age)

Answer 1

Men and Women > 40

Question 2

What 15 patients to screen regardless of age and sex?

Answer 2

• Established ASCVD
• AAA
• DM
• Hypertension
• Smoking
• Stigmata of dyslipidemia
• Premature ASCVD history in family hx
• Family history of DSL
• CKD < 60
• Obesity > 30
• Inflammatory diseases
• HIV
• ED
• COPD
• History of hypertensive pregnancy

Question 3

in IR patients, what are 5 other lipid modifiers to start statin therapy?

Answer 3

• LDL > 3.5
• APO B > 1.05
• Non HDL > 4.2
• Lp(a) > 50 mg/dl
• Low HDL

Question 4

In IR patients, what are the additional risk factors (Not risk modifier), to start lipid therapy in Men > 50 or Women > 60

Answer 4

• IFG
• High Waist Circumference
• Smoker
• Htn

Question 5

What are 3 other risk modifiers for patients in IR category (covered Lipid ones, and risk factors)

Answer 5

HsCRP > 2

CAC > 0

History of premature CAD

Question 6

What are LDL, ApoB and Non-HDL thresholds to start statins in low risk patients

Answer 6

• LDL > 5.0
• Apo B > 1.45
• Non HDL > 5.8

Question 7

What are LDL, ApoB and Non HDL targets for primary prevention?

Answer 7

LDL < 2

ApoB < 0.8

-Non HDL < 2.6

Question 8

What is the criteria for statin indicated condition with Diabetes?

Answer 8

Age > 40

Age > 30 and DM > 15 years duration

Microvascular disease

Question 9

What is statin indicated condition for CKD?

Answer 9

-Age > 50 years and GFR < 60 or ACR > 3

Question 10

What is LDL, ApoB and Non HDL targets in low risk patients who meet criteria for statin?

Answer 10

• LDL < 2.5 or 50% reduction
• ApoB < 0.85 g/l
• Non HDL < 3.2 mmol/l

Question 11

What is LDL, ApoB and Non HDL targets in IR risk patients who meet criteria for statin?

Answer 11

LDL < 2

ApoB < 0.8

Non HDL < 2.6

Question 12

What is LDL, ApoB and Non HDL targets in high risk patients who meet criteria for statin?

Answer 12

LDL < 1.8

Non HDL < 2.4

ApoB < 0.7

Question 13

When should CAC scoring be used?

Answer 13

-In patients above 40 years old who are IR and need to make decision about treatment

Question 14

Three patient population that CAC scoring should not be done?

Answer 14

• Asymptomatic low risk patients
• High risk
• On statins

Question 15

When can CAC score be considered in low risk individuals ?

Answer 15

over 40 years old with a family history of premature ASCVD

Question 16

What subtypes of secondary prevention patients have been shown to derive the largest benefit from intensification of statin therapy?

Answer 16

• Up to 1 year post ACS
• Diabetes
• Symptomatic PAD
• More than 1 bed of vascular disease
• Recurrent MI
• MI in past 2 years
• Previous CABG
• LDL > 2.6 or Heterozygous FH
• Lp(a) > 60 mg/dl

Question 17

What is the dose of Icosapent ethyl?

Answer 17

2000mg BID

Question 18

What are FH screening criteria? (2)

Answer 18

LDL > 5 mmol/l if more than 40 years old

LDL > 4.5 if 18-39 years old

LDL > 4 if less than 18

Question 19

What are the three major criteria for FH?

Answer 19

• DNA Mutation
• Tendon Xanthomas
• LDL > 8.5

Question 20

What are the 2 minor criteria for FH?

Answer 20

FDR with elevated LDL

Proband or FDR with premature ASCVD

Question 21

Should patients with FH get genetic testing?

Answer 21

Yes, for cascade screening

Question 22

When should PCSK9 Inhibitors be used in patients with FH?

Answer 22

If they have not achieved a 50% reduction below LDL 3.5 mmol/l

Question 23

How should statins and Ezetimibe be managed in Pregnancy in Women with FH?

Answer 23

Statins and Ezetimibe should be stopped due to teratogenic risk

(And during Breastfeeding)

Question 24

What is the LDL target for those with FH?

Answer 24

-LDL < 50% and LDL < 2.5 (less than 2 if ASCVD)

Question 25

What do you need to do in Women that have pregnancy complications ? (GDM, HTN, Preeclampsia, Preterm birth, Stillbirth, Low birth weight infant, Placental abruption)

Answer 25

Lipid panel in the late postpartum period

Question 26

What to use in Women with pregnancy complications in place of 10 year calculators?

Answer 26

CV age