Chapter 27: Dyslipidemia

Question 1

What is cholesterol? What is its role in the body?

Answer 1

Cholesterol is an important component of healthy cells. It makes up cell walls, it is used in the synthesis of hormones, and it creates bile acids

Question 2

What are bile acids?

Answer 2

Bile acids are created by the liver and sent to the small intestine. They come here to absorb the fat that is found in the small intestine.

Question 3

What is enterohepatic recycling?

Answer 3

After the bile acids absorb the fat in the small intestine, they turn into bile salts which are then returned to the liver.

Question 4

How does cholesterol exit the body?

Answer 4

It exits the body as either free cholesterol or bile acids

Question 5

What does Ezetimibe do?

Answer 5

Ezetimibe blocks the absorption of cholesterol in the intestines which then ultimately causes a decrease in cholesterol in the person.

Question 6

What do Bile-Acid Sequestrants (Such as Colesevelam) do?

Answer 6

They block the enterohepatic circulation which then causes a decrease of cholesterol in the person.

Question 7

What do statins do?

Answer 7

They block the formation of statins.

Question 8

What do statins do?

Answer 8

They block the formation of statins.

Question 9

What is atherosclerosis?

Answer 9

This is the build-up of plaque upon the inner walls of the arteries. This plaque is made up of cholesterol, fats, and other such materials. Atherosclerosis ultimately leads atherosclerotic cardiovascular disease (ASCVD) such as MI, strokes, angina, and peripheral arterial disease.

Question 10

What are the 3 types of cholesterol?

Answer 10

1. HDL: This is the good lipoprotein: It transports lipoproteins to the liver for removal from the body.
2. LDL: Bad lipoprotein
3. VLDL: Bad lipoprotein
4. Having a high triglyceride level is also associated with cardiovascular disease. Greater than 500 mg/dl is considered hypertriglyceridemia.

Question 11

What is dyslipidemia?

Answer 11

Dyslipidemia means having unhealthy levels of lipoproteins. It can either be primary or secondary. Primary dyslipidemia means that the dyslipidemia is caused by genes passed down by family. Secondary means it is caused by lifestyle, medical conditions, poor diet and exercise, etc…

Question 12

How are cholesterol levels determined?

Answer 12

Lipid panels are taken after a 9-12 hour fast. If that’s not used, the friedewald equation is used: LDL=TC-HDL-TG/5. However, the friedewald equation is not used when the TG level is above 400 mg/dl.

Question 13

What are the values listed in the lipid chart?

Answer 13

Non-HDL: <130 desirable
LDL: <100 desirable
         >190 Very high
HDL: >40 (men): Desirable
         >50 (Women): Desirable
Triglycerides: <150 mg/dl: Desirable
                        >500 mg/dl: Very high

Question 14

What organization provides the treatment principles for treating dyslipidemia?

Answer 14

American College of Cardiology/American Heart Association (ACC/AHA)

Question 15

What is ASCVD Risk?

Answer 15

ASCVD risk calculation is a calculation done to estimate an individual’s risk of having a cardiovascular event (MI, stroke, or death) in the next 10 years. Providers use this to determine the risk of the individual and based on that make a decision on how to treat them. The risk calculator is available online.

Question 16

What are some natural products to treat dyslipidemia?

Answer 16

• Red yeast rice: It contains natural HMG-COA Reductase Inhibitors
• Omega 3 fatty acids: It lowers LDL.

Question 17

What are some natural products to treat dyslipidemia?

Answer 17

• Red yeast rice: It contains natural HMG-COA Reductase Inhibitors
• Omega 3 fatty acids: It lowers LDL.

Question 18

What does non-drug treatment for dyslipidemia consist of?

Answer 18

1. Eating a proper diet (Eat fruits, vegatables, fish, and water)
2. Conducting aerobic exercise about 4 times a week.
3. Don’t drink or smoke.

Question 19

What are some things to know about liver damage?

Answer 19

Cholesterol-lowering drugs can potentially cause liver damage. This includes, fibrates, statins, or ezetimibe. Do not use these drug when AST and ALT levels are 3 times above the normal amount.

Question 20

What is the mechanism of action of statins?

Answer 20

Statins inhibit HMG-COA Reductase. This enzyme turns HMG-COA Reductase into Mevalonate. By doing this, cholesterol is lowered. The correct intensity has to be used for the right person in order to lower their cholesterol.

Question 21

You must know the chart that displays the high-intensity, medium-intensity, and low-intensity strengths of the statins. It is on Page 434.

Question 22

What are the high intensity statins?

Answer 22

Atorvastatin 40-80 mg

Rosuvastatin 20-40 mg

Question 23

What are the Moderate intensity statins?

Answer 23

Atorvastatin 10-20 mg
Rosuvastatin 5-10 mg
Simvastatin 20-40 mg
Pravastatin 40-80 mg
Lovastatin 40 mg
Fluvastatin 40 mgBID/80 mg XL
Pitavastatin 2-4 mg

Question 24

What are the Low-Intensity Statins?

Answer 24

Simvastatin 10 mg
Pravastatin 10-20 mg
Lovastatin 20 mg
Fluvastatin 20-40 mg
Pitavastatin 1 mg