Dislipidemia Flashcards
which 5 factors automatically warrant statin therapy?
High LDL-c with any of:
1) diabetes
2) clinical atherosclerosis
3) very high/significant LDL>5 or familial hypercholesterolemia
4) CKD
5) abdominal aortic aneurysm (>3cm or prior surgery)
If a patient has a FRS score of 15% in the next 10 years, and has a first degree of relative who had a major cardiac event before age 50 (man) or age 60 (woman), what his modified FRS now?
30%! DOUBLE the risk when a first degree relative has early onset Cardiac event.
What’s the mechanism of statin?
decrease biosynthesis of cholesterol in liver by competitively inhibits HMG-CoA enzymes.
risk/side effect of statin
myalgia (2-13%)
myonecrosis (<0.5%)
rhabdomyolysis (<0.1%)
What baseline laboratory investigations will you order when starting the statin?
Creatinine kinase (CK), AST&ALT
The patient is started on a statin and baseline CK, AST and ALT levels are normal. How often should these levels be monitored?
No need to monitor
It is prudent to periodically assess for adherence to medication and lifestyle interventions, while also inquiring about side effects.
Patient is on statin. The patient notes their “good cholesterol” (HDL-C) is low and asks what you would recommend to improve it?
Exercise!
niacin is not recommended in combination with statin use as it may lead to toxicity.
what are the main concerns with a high triglyceride?
Cardiovascular risk + pancreatitis
Is LDL-c directly measured?
LDL cholesterol is not directly measured, but is instead calculated using the Friedewald equation:
LDL cholesterol = Total cholesterol – HDL cholesterol – [Total triglyceride ÷ 2.19]
which options to lower triglyceride levels would be your first recommendations for this patient?
abstain from EtOH and very low-fat diet
pharmacotherapy to lower triglyceride?
Fibrate, fish oil, and less effectively nicotinic acid.
attention: Avoid using fibrate with statin together as toxiology
If this patient’s fasting triglyceride level was 5.0 mmol/L, which medication would you select to provide the greatest overall benefit?
Treatment for a triglyceride level < 11 mmol/L may be more justified to reduce cardiovascular risk rather than to prevent pancreatitis. While there is no good evidence that an elevated triglyceride level directly causes cardiovascular disease, it does signals increased risk. A statin medication has the best evidence in reducing this risk,
what to do when LDL not dropping to target after statin?
consider adding ezetimibe, which is a medication to reduce cholesterol absorption in the gut.
things to consider when pt report severe side effects of statin?
1) stop the statin until the SSx resolved or underlying causes are identified
2) is there a drug-drug interaction, for example, fibrate use together with statin?
3) does patient has hypothyroid or Vit D deficiency? if yes, supplement.
4) Switch to the type of statins that have less side effect profile? e.g, fluvastatin, pravastatin
