CPG On Dyslipidemia

Question 1

Can you start a statin therapy for a px without ASCVD but is 46 male, hypertensive With ldl 131 mg/dl?

Answer 1

Yes

Start statin therapy for pxs >45 with >2 risk** factors with ldl >130 mg/dl

** *Risk factors are: male sex, postmenopausal women,
smoker, hypertension, BMI > 25 kg/m2, family history of
premature CHD, microalbuminuria, proteinuria, and left
ventricular hypertrophy.

Question 2

Can statins be started on pxs without ASCVD but are known diabetics?

Answer 2

Yes

Question 3

Percent reduction in LLD C of moderate intensity statin?

Answer 3

31-50%

Low intensity 20-30

High >50

Question 4

CPG goal for statin therapy in terms of LDL C REDUCTION?

Answer 4

30%

or a target level of <70 mg/dl

Question 5

When should you request for lipid profile?

Answer 5

Monitoring response of pxs with ASCVD and diabetics on statin therapy

Screening for pxs >45, + 2 or more risk factors

Question 6

Using the Dutch Lipid Network criteria on the diagnosis of

heterozygous familial hypercholesterolemia what is the cut off score for definite disease?

Answer 6

> 8

Question 7

Time to achieve lipid targets based on clinical trial is?

Answer 7

1-8 years

Question 8

For primary prevention, monitoring of lipid profile to determine treatment goals is done when?

Answer 8

After 3 months of tratment

Question 9

Type of statin therapy needed for patients with familial hypercholesterolemia

Answer 9

High intensity statin

Question 10

Patient is 48/M hypertensive, lipid profile revealed LDL is 120 mg/dl what is the next step?

Answer 10

Reassess after 6-8 weeks

Question 11

RF to consider for statin therapy?

Answer 11

Male
Hypertensive >140/90
BMI >25
Family hx of premature CAD
Proteinuria
LV hypertrophy
Post menopausal women

Question 12

When should baseline transaminase level determination be done for statin therapy?

Answer 12

Prior to initiation of therapy for patients at risk to develop liver injury

Question 13

Patient presented to you with SGPT 2x above normal on statin therapy. What is the next step?

Answer 13

Continue therapy and workup for other causes of SGPT elevation

Question 14

Patient on statin therapy presented to you with SGPT 3x above normal. What is the next step?

Answer 14

Stop statin and recheck ast/alt after 2 weeks

For individuals high risk to develop CVD use non statin based ldl c lowering agent

Question 15

After 2 weeks of stopping statin therapy you checked patients SGPT and it was still >3x above normal. What is the next step

Answer 15

Consider other cause of elevation

Rechallenge at lower dose, with different metabolism type or use non statin based therapy + low dose statin

Question 16

After 2 weeks of statin holiday you rechecked SGPT and it was 2x above normal. What is the next step?

Answer 16

Resume statin at a lower dose or start with another type of statin therapy

Question 17

Patient on statin therapy developped rhabdomyolysis what is the next step?

Answer 17

6 weeks drug holiday

Question 18

Statin that can be used after rhabdomyolysis has resolved?

Answer 18

Rosuvastatin at alternate or weekly dosing and at low dose

Question 19

Patient on statin therapy came in with CK >5x normal, claims he can tolerate the pain, no organ damage seen on examination what is the next step?

Answer 19

Wait for symptoms to disappear and start a lower dose

Question 20

When are fibrates indicated in dyslipidemia?

Answer 20

Consider fibrates if TG is >204 mg/dl and Hdl is <34 mg/dl