CCS Dyslipidemia 2021 Guidelines + FH Flashcards
Who to screen regardless of risk factors (Based on sex and age)
Men and Women > 40
What 15 patients to screen regardless of age and sex?
- 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
in IR patients, what are 5 other lipid modifiers to start statin therapy?
- LDL > 3.5
- APO B > 1.05
- Non HDL > 4.2
- Lp(a) > 50 mg/dl
- Low HDL
In IR patients, what are the additional risk factors (Not risk modifier), to start lipid therapy in Men > 50 or Women > 60
- IFG
- High Waist Circumference
- Smoker
- Htn
What are 3 other risk modifiers for patients in IR category (covered Lipid ones, and risk factors)
HsCRP > 2
CAC > 0
History of premature CAD
What are LDL, ApoB and Non-HDL thresholds to start statins in low risk patients
- LDL > 5.0
- Apo B > 1.45
- Non HDL > 5.8
What are LDL, ApoB and Non HDL targets for primary prevention?
LDL < 2
ApoB < 0.8
-Non HDL < 2.6
What is the criteria for statin indicated condition with Diabetes?
Age > 40
Age > 30 and DM > 15 years duration
Microvascular disease
What is statin indicated condition for CKD?
-Age > 50 years and GFR < 60 or ACR > 3
What is LDL, ApoB and Non HDL targets in low risk patients who meet criteria for statin?
- LDL < 2.5 or 50% reduction
- ApoB < 0.85 g/l
- Non HDL < 3.2 mmol/l
What is LDL, ApoB and Non HDL targets in IR risk patients who meet criteria for statin?
LDL < 2
ApoB < 0.8
Non HDL < 2.6
What is LDL, ApoB and Non HDL targets in high risk patients who meet criteria for statin?
LDL < 1.8
Non HDL < 2.4
ApoB < 0.7
When should CAC scoring be used?
-In patients above 40 years old who are IR and need to make decision about treatment
Three patient population that CAC scoring should not be done?
- Asymptomatic low risk patients
- High risk
- On statins
When can CAC score be considered in low risk individuals ?
over 40 years old with a family history of premature ASCVD
What subtypes of secondary prevention patients have been shown to derive the largest benefit from intensification of statin therapy?
- 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
What is the dose of Icosapent ethyl?
2000mg BID
What are FH screening criteria? (2)
LDL > 5 mmol/l if more than 40 years old
LDL > 4.5 if 18-39 years old
LDL > 4 if less than 18
What are the three major criteria for FH?
- DNA Mutation
- Tendon Xanthomas
- LDL > 8.5
What are the 2 minor criteria for FH?
FDR with elevated LDL
Proband or FDR with premature ASCVD
Should patients with FH get genetic testing?
Yes, for cascade screening
When should PCSK9 Inhibitors be used in patients with FH?
If they have not achieved a 50% reduction below LDL 3.5 mmol/l
How should statins and Ezetimibe be managed in Pregnancy in Women with FH?
Statins and Ezetimibe should be stopped due to teratogenic risk
(And during Breastfeeding)
What is the LDL target for those with FH?
-LDL < 50% and LDL < 2.5 (less than 2 if ASCVD)
What do you need to do in Women that have pregnancy complications ? (GDM, HTN, Preeclampsia, Preterm birth, Stillbirth, Low birth weight infant, Placental abruption)
Lipid panel in the late postpartum period
What to use in Women with pregnancy complications in place of 10 year calculators?
CV age
