drugs and lipids Flashcards
what is primary and secondary CV prevention
primary - prevent first heart attack
secondary - prevent second
4 non midfiable risk factors
- age
- sex
- fami. Hx
- women after menospause
5 modifiable
- diabetes
- smoking
- hypertension
- dyslipidmeia
- obesity
main apo of LDL and HDL
LDL - apoB
HDL - apoA-1
what is key to mgmt
LDL reduction
what is endogenous metabolism of lipoproteins
- VLDL produced in liver and deliver to blood
- VLDL hydrolized to IDL by LPL
- IPL hydrolyzed to LPL by hepatic lipase
- LDL can then be delver to tissues (or make plaques), or make be taken up by liver via LPL-r
what is role of LDL in atherosclerosis
- adhesion molecule allows it to stick
- pulled into endothelium
- macrophages scavenge
- SMC cells migrate into wall
what is FH
defect in LDL-R that means LDL not taken up by liver
Sx of FH
high LDL, xanthomatas, tnedon thickening
what are statins
HMG CoA reductase inhibitor - slows rate limiting step of chol. synthesis
how does stain work (2)
- inhbits HMG CoA reduct - stop chol syn
2. turns on gene that encodes for LDL-r - pulls in more LDL
what is effect of lowering LDL by one mmol/L
drop CHD risk by 20%
4 steps to lipid lowering
- risk assessment
- set treatment target
- select best agent
- monitor and encourage
** what is total C calc?
Total = VLDLc +LDLc + HDLc
what is calculation for VLDLc
TG/2.2
** what is LDLc calc?
TC - HDLc - (TG/2.2 or VLDLc)
what is high risk
framingham over 20%
4 risk modifiers not in framingham
- family (up to 2x)
- metabolic (up to 2X)
- genetic cause (FH)
- high hsCRP
what is rule of 6
after initial statin dose, will only get a 6% increase by doubling the dose
what is ezetimibe
intestinal chol. absorption inhib
what is ezitimibe eff?
18% reduction in LDL
what is SEff for statins
skeletal myalgia
liver - transmintis
renal - safe
what is moderate and high hypertriglyceridemia and what does it signal risk of
moderate - TG 3-10 - CHD
high > 10 - acute pancreatitis
what is enzyme responsible for TG breakdown
LPL
what can be given for hyperTG
fibrates -activate LPL
what is often overlooked pattern in CHD
modest incr. in TG and modest drop in HDL
what correlates with this picture
high visceral fats
what is metabolic syndrome
central obesity + 2 of:
TG > 1.7
HDH in men < 1.03 women 130/85
fasting glucose > 5.6
what is large waist
men > 94cm
women > 80
steps to treat mixed dylipipdemia
- assess risk with frame + metabolic adjustment
- lifestyle measures with key being weight loss
- use pharma is needed for CVD risk
