Dyslipidemia

Question 1

What is atherosclerosis?

Answer 1

formation of fibrous plaques and advanced lesions

Question 2

What is cholesterol?

Answer 2

a waxy fat (lipid) carried through the blood by lipoproteins. The two main types are HDL and LDL

Question 3

What makes up the cholesterol panel?

Answer 3

Total cholesterol
LDL cholesterol
HDL cholesterol
HDL/Total cholesterol ratio

Non-HDL cholesterol
total cholesterol - HDL
accounts for other cholesterol particles (VLDL)
should be less than or equal to 30mg/dl above the LDL-C

Question 4

How do you calculate the non HDL cholesterol ?

Answer 4

total cholesterol - HDL

Question 5

What is primary prevention?

Answer 5

no signs of CV disease
treatment aimed at preventing disease from manifesting

Question 6

What is secondary prevention?

Answer 6

CV disease is present
-clinical CHD
-symptomatic carotid artery disease
-peripheral arterial disease
-abdominal aortic aneurysm
-DM
treatment aimed at preventing further progression of the disease

Question 7

For primary prevention, all persons _______ y/o should have a +/- fasting cholesterol panel every _________ years. Intensity of risk reduction should be adjusted to absolute risk of CHD.

Need to assess a persons risk of CVD
1.
2.
3.

Answer 7

20
5

1. measure lipids
2. count major risk factors
3. estimate 10 year CHD risk

Question 8

What are primary risk factors?

Answer 8

cigarette smoking
age (male >45, female >55)
low HDL (<40)
HTN (140/90 or meds)
FH of premature heart disease
- first degree male relative < 55
-first degree female relative < 65

High HDL is a negative risk factor

Question 9

What are secondary risk factors?

Answer 9

life habit
1. obesity
2. inactivity
3. athrogenic diet

emerging
1. lipoprotein a
2. homocysteine
3. impaired fasted glucose
4. prothrombotic factors
5. proinflammatory factors

Question 10

If the ASCVD is greater than ___________ = cholesterol meds. If it is less than this than just do monitoring and further risk assessment and if they are at higher risk then do a _____________.

Answer 10

7.5
calcium score

Question 11

The national cholesterol education program (NCEP) follows treat to target guideline. What does this mean?

Answer 11

e.g. pt has LDL of 140 and the goal is 100. Start with Atorv 10 and Increase mg of meds until you get to the target. The issue is that people may not want to up the dose.

Question 12

The ACC/AHA 2013 follows the targeted statin intensity guideline. What does this mean?

Answer 12

Start with a higher dose of meds. Then check LDL and increase treatment to get to goal. So start higher and keep increasing if don’t reach target

Question 13

Primary prevention treatment Guidelines (treat to target)

high risk patients:
moderately high risk patients:
moderate risk patients:
low risk patients:

Answer 13

LDL lowered to <100
LDL lowered to <100
LDL lowered to <130
LDL lowered to <160

Question 14

Targeted statin intensity: focus on reducing risk of ASCVD in four statin benefit groups:

Answer 14

1. persons with clinical ASCVD
2. persons with primary elevation of LDL greater than or equal to 190
3. persons with DM aged 40-75 with LDL levels of 70-189
4. persons without clinical ASCVD or DM who have LDL levels 70-189 with an estimated 10 yr risk of 7.5% or greater

Question 15

Targeting treatment, secondary prevention: the goal of the treatment is to
1.
2.

Answer 15

lower LDL and slow further atherosclerosis
1. LDL goal would be less than or equal to 100mg/dl
2. LDL goal would be less than or equal to 70mg/dl

Question 16

What are examples of high intensity statin therapy

Answer 16

atorvastatin 40mg +
Rosuvastatin 20 mg+

Question 17

What are examples of low intensity statin therapy

Answer 17

pravastatin 10mg+
Lovastatin 20mg+

Question 18

The very high LDL is defined as being greater than or equal to ____________. Usually have a genetic form:
1.
2.
3.

This requires combined therapy

Answer 18

190

1. monogenic familial hypercholesterolemia
2. familial defective apolipoprotein B
3. polygenic hypercholesterolemia

Question 19

What is the treatment of dyslipidemia ?

Answer 19

1. lifestyle modification
   -low fat/cholesterol diet
   -exercise
2. Drug therapy
   - LDL= statins, ezetimibe, PCSK9 inhibitors
   -HDL= niacin +/- fibrates, +/- statins
   -Triglycerides = fibrates, niacin, fish oil

Mixed dyslipidemia may require multiple meds.

Question 20

The PCSK9 inhibitors are monoclonal antibody. It is an injectable medication. It is indicated for:
1.
2.

Early data suggests a marked reduction in ________________

Answer 20

adjunctive treatment with statin in known cardiac disease
for patients with a high LDL

CV events

Question 21

Apolipoproteins:
1. Apo B ………
2. Apo A1………

Answer 21

1. Apo B is related to LDL and “unlocks the cells to deliver cholesterol”
   -high levels in HD
   -may be used to assess genetic link
2. Apo A1: linked to HDL
   low levels associated with decreased HDL

Question 22

Metabolic syndrome consists of any 3 of the following

Answer 22

1. HTN >130/85
2. Triglycerides greater than or equal to 150
3. HDL: <40 (males) <50 (females)
4. Abdominal obesity (wasit is greater than or equal to 40 > M) (waist is greater than or equal to 35 > F)
5. Impaired fasting glucose greater than or equal to 110

Question 23

In metabolic syndrome, there is an atherogenic pattern…..
____________ + _____________ = _____________

Answer 23

increased triglycerides + decrease in HDL cholesterol = small dense LDL “light fluffy” kind

Question 24

Metabolic syndrome involves factors such as
1.
2.
3.
4.
5.

It is secondary target of risk reduction after ______________

Answer 24

Atherogenic cholesterol
Insulin resistance
Hypertension

Prothrombotic State
Proinflammatory State

LDL

Question 25

What is the treatment for metabolic syndrome?

Answer 25

reduce underlying cause
-intensive weight management
-increase physical activity

treat associated lipid and non lipid risk factors
-treat HTN
-use ASA to decrease prothrombotic state
- treat TG and HDL (converrts LDL to light fluffy, less athergenic than LDL)