Drugs for Dyslipidemias Flashcards
When did the Framingham Heart Study begin?
1948
What cardiovascular risk factor was directly linked to coronary heart disease (CHD) in 1961?
High LDL levels
How does HDL relate to CHD risk?
Inverse relationship (higher HDL = lower CHD risk)
Do high triglycerides (VLDL) increase CHD risk?
Yes, but not as strongly as LDL
What are the main functions of cholesterol?
Provides membrane rigidity
Precursor to steroid & stress hormones, vitamin D
Precursor to bile acids for fat digestion
What percentage of cholesterol is produced by the body vs. obtained from the diet?
80% endogenous synthesis, 20% from diet
Why is LDL called “bad cholesterol”?
Contributes to plaque buildup in arteries → increases CHD risk
What is the risk threshold for LDL levels?
> 130 mg/dL increases CHD risk
Why is HDL called “good cholesterol”?
Removes excess cholesterol from tissues → lowers CHD risk
What is the risk threshold for low HDL levels?
<40-50 mg/dL increases CHD risk
How do high triglycerides (VLDL) impact health?
Increase risk of CHD and pancreatitis
What percentage of total calories should come from fat to lower LDL?
<30%
What is the recommended daily cholesterol intake?
<200 mg/day
What dietary components help reduce LDL levels?
Fiber & plant sterols (e.g., Benechol™, Smart Balance®)
What other components help reduce LDL levels?
Omega 3 fatty acid oils (fish oil)
Exercise and calorie reduction
What is the first-line medication for lowering LDL?
Statins
How do bile acid sequestrants lower LDL?
Bind bile acids, forcing the body to use cholesterol to make more
What do PCSK9 inhibitors do?
Increase LDL receptor activity, enhancing LDL clearance
How does ezetimibe work?
Inhibits cholesterol absorption in the intestine
What are three common statins?
Atorvastatin (Lipitor®)
Rosuvastatin (Crestor®)
Simvastatin (Zocor®)
What enzyme do statins inhibit?
HMG-CoA reductase
How do statins lower LDL levels?
Inhibit cholesterol synthesis → Liver upregulates LDL receptors → More LDL is removed from the blood
What is the net effect of statins?
Reduced serum LDL → Decreased CHD risk
What is the most severe adverse effect of statins?
Rhabdomyolysis (muscle breakdown → kidney failure)
What are common mild side effects of statins?
Muscle weakness & pain
What rare liver-related side effect can statins cause?
Hepatotoxicity
Which medications can increase statin levels?
Antifungals & antibiotics that inhibit CYP3A4
What is the most effective drug class for lowering triglycerides?
Fibrates (Gemfibrozil, Fenofibrate)
How do fibrates lower triglycerides?
Activate PPAR-α → Increases fatty acid metabolism → Lowers VLDL levels
How do fish oil supplements help lower triglycerides?
Work similarly to fibrates by increasing fatty acid metabolism
What is the AHA recommendation for omega-3 intake?
Two servings of fatty fish per week
Which statins can also lower triglycerides?
Atorvastatin & Rosuvastatin (less effective than fibrates)
How do high triglycerides increase CHD risk?
Contribute to arterial plaque formation
What serious condition can occur if triglycerides exceed 500 mg/dL?
Acute pancreatitis
Are statins only used for treating heart disease?
No, they are also prescribed for prevention.
Why should dentists be aware of patients taking statins?
Potential drug interactions & comorbidities (hypertension, diabetes, atherosclerosis).
Which antifungals and antibiotics can inhibit statin metabolism?
Fluconazole, Itraconazole, Erythromycin
Why is inhibiting statin metabolism a concern?
Increases statin plasma levels → Higher risk of muscle toxicity
