Cholesterol

Question 1

Lipids and their normal values

Answer 1

Total Cholesterol- <200
HDL 40-60
LDL- <100 optimally <130 NCEP
Triglycerides- <150

Question 2

Adult Treatment Panel (ATP) III

Answer 2

Risk factor counting
Treat to LDL goal
Address non-hdl target

Question 3

Adult Treatment Panel (ATP) IV

Answer 3

There is no target
The intensity of statin therapy is the focus of treatment

Strengths- Encourages a “risk discussion” with patients in regards to primary prevention
Strictly evidence based
The bulk of the content is undisputed
10 year risk of ASCVD includes CHD & stroke
More relevant for women and AA populations

Weaknesses-Strictly evidence based
Limited or NO DATA for > 75 and < 40
The risk calculator is controversial* and may significantly overestimate risk
Forgotten populations: diabetics < 40 y/o and other high risk groups
Younger patients often have a high lifetime risk and a low short term (10 year) risk

Question 4

The Four Statin Benefit Groups

Answer 4

1) Secondary Prevention in those with clinical ASCVD
2) Primary Prevention in those with LDL ≥ 190
3) Primary Prevention in those with DM, age 40-75, with LDL 70-189
4) Primary Prevention in those without DM, age 40-75, with LDL 70-189, & a 10 year ASCVD risk ≥ 7.5%

Question 5

Lipid Medications

Answer 5

Statins
Lowers Total cholesterol
Lowers LDL
Myopathy-CPK
LFTs-AST (5-40)  2-3 times higher

Niacin
Increases HDL

Fibrates
Decreases Trigs

Selective cholesterol absorption inhibitors
Zetia

Resins
bile acid sequestrant or bile acid-binding drugs

Question 6

Moderate Intensity Statin Therapy

Answer 6

MODERATE intensity lowers LDL by 30-49%

Atorvastatin 10 or 20 mg
Rosuvastatin 5 or 10 mg

Simvastatin 20 or 40 mg
Pravastatin 40 or 80 mg
Lovastatin 40 mg
Fluvastatin 40 mg BID

Question 7

High Intensity Statin Therapy

Answer 7

HIGH intensity lowers LDL by ≥ 50%

Atorvastatin 40* or 80 mg
Rosuvastatin 20 or 40 mg

Ideal down-titrated to 40mg when 80 was not tolerated

Question 8

Hyperlipidemia

Answer 8

An abnormally high concentration of fats or lipids in the blood.

Lifestyle Modifications
3 month
Diet Low in saturated fat
Increase Physical Activity
Increase HDL
Stop Tobacco
Increase HDL

Question 9

PCSK9

Answer 9

Evolocumab (Repatha)
Approved  8/27/2015 
Manufacturer is Amgen
Dosage: 140 mg every 2 weeks or 420 monthly.
Prefilled autoinjector
Cost $14,100 annually for every 2 weeks

Amgen 1-27-2016

Side Effects- Rash, itching, hypersensitivity vasculitis
Most common nasopharyngitis, injection site reactions, influenza
Confusion, memory impairment .08% of patients
Elevated liver enzymes