Dyslipidemia Flashcards
peripheral arterial disease
a condition in which narrowed arteries reduce blood flow to the extremities, typically the legs, due to atherosclerosis, leading to symptoms like pain, cramping, and impaired circulation.
Pooled Cohorts Equations are
race-and sex-specific equations used to predict a 10-year ASCVD risk and work best in individuals of age 40-75 years who have no history of ASCVD, severe hypercholesterolemia, or diabetes.
hypercholesterolemia
a medical condition characterized by abnormally high levels of cholesterol in the blood, increasing the risk of atherosclerosis and cardiovascular disease.
If atherosclerosis occurs in the coronary artery, it can result in
stable angina and ACS
ACS includes
unstable angina and myocardial infarction
If atherosclerosis occurs in the brain artery, then it can cause
ischemic stroke or TIA (Transient ischemic attack)
If atherosclerosis occurs in the major arteries in the limbs, then it can lead to
peripheral arterial disease, also called peripheral vascular disease.
reducing the risk for ASCVD is the main goal of
lipid-lowering therapy. This means that we determine the need for lipid-lowering therapy based on the individual’s risk for ASCVD, not just based on the individual’s blood lipid levels.
What is the primary reason for prescribing lipid-lowering therapy in a patient with a history of ASCVD?
Lipid-lowering therapy is prescribed to prevent the recurrence of ASCVD in patients with a history of the condition.
When is lipid-lowering therapy recommended for a patient with severe hypercholesterolemia (LDL cholesterol of at least 190) even if they have no history of ASCVD?
Lipid-lowering therapy is recommended for severe hypercholesterolemia, even without prior ASCVD, due to the high risk of developing ASCVD.
Why are patients with diabetes considered to have an increased risk of ASCVD?
Patients with diabetes are at an increased risk of ASCVD, which is why they are candidates for lipid-lowering therapy.
How is the need for lipid-lowering therapy determined for individuals who haven’t had ASCVD, don’t have severe hypercholesterolemia, or diabetes?
For those without ASCVD, severe hypercholesterolemia, or diabetes, the need for lipid-lowering therapy is determined by predicting their ASCVD risk using Pooled Cohorts Equations.
What do the Pooled Cohorts Equations predict, and why are they used?
Pooled Cohorts Equations predict a 10-year risk of fatal and non-fatal MI and ischemic stroke, which are part of ASCVD. They are used to assess the need for lipid-lowering therapy.
Why are the equations called “Pooled Cohorts”?
The equations are called “Pooled Cohorts” because they were derived from data compiled from 5 community-based cohorts representing the US population.
What patient factors are used in the Pooled Cohorts Equations to predict ASCVD risk?
The Pooled Cohorts Equations use age, sex, race, systolic blood pressure, total cholesterol, HDL-cholesterol, diabetes status, smoking status, and hypertension treatment status as variables to predict a 10-year risk of ASCVD.
How can a healthcare provider determine the right Pooled Cohorts Equation for a patient’s specific sex and race?
The American College of Cardiology has a website that can automatically select the appropriate equation based on the patient’s specific sex and race.
What are the four risk categories based on the 10-year risk of ASCVD?
- low risk (less than 5%)
- borderline risk (5% to less than 7.5%)
- intermediate risk (7.5% to less than 20%)
- high risk (at least 20%).
What are the limitations of the Pooled Cohorts Equations in predicting ASCVD risk?
- being less accurate for individuals who are not non-Hispanic whites or blacks
- those younger than 40 or older than 75
- the dominance of age in risk scoring, potentially overestimating risk in the elderly.
Why can advanced age alone lead to a high-risk classification, according to the Pooled Cohorts Equations?
Age dominates risk scoring in the equations, and advanced age can lead to a high-risk classification even if other variables are not significant.
What important risk factors for ASCVD are not included in the Pooled Cohorts Equations?
The equations do not include all known risk factors for ASCVD, such as chronic inflammatory diseases and family history.
What should be investigated for the treatment of hyperlipidemia, and what are some secondary causes to consider?
Investigate secondary causes of hyperlipidemia, including medications, when treating hyperlipidemia.
What lifestyle therapies should be a part of any lipid-lowering treatment regimen?
- healthy diet
- regular exercise
- weight loss
How can lipid-lowering medications be classified, and what is the priority for treatment unless certain conditions exist?
can be classified as LDL-C-lowering and TG-lowering, with the priority being to lower LDL-C unless the patient has severe hypertriglyceridemia.
What is the main goal of lipid-lowering therapy, and which medications have been shown to reduce the risk of ASCVD?
The main goal of lipid-lowering therapy is to reduce the risk of ASCVD, and medications like statins, statin plus ezetimibe, statin plus a PCSK9 inhibitor, and statin plus icosapent ethyl have been shown to achieve this goal.
Which lipid-lowering medications are primarily used to lower triglycerides?
Fibrates and omega-3 fatty acids are primarily used to lower triglycerides.
What is the concern regarding niacin when used with a statin in terms of ASCVD risk?
Niacin has been shown to cause harm without lowering the ASCVD risk when used in combination with a statin.
What should be checked when a patient presents with hyperlipidemia or difficulty in controlling blood lipid levels while on lipid-lowering medication?
Diet, medications, and other disease states should be evaluated to determine the cause of hyperlipidemia or difficulty in controlling blood lipid levels.
How can the intake of certain dietary components impact LDL cholesterol and triglyceride levels?
The intake of saturated or trans fats can increase LDL cholesterol, while high intake of refined carbohydrates and excessive alcohol can increase triglyceride
What are some medications that can increase LDL cholesterol levels, and what should be done if these medications are used without a clear indication?
Medications such as diuretics, amiodarone, glucocorticoids, and cyclosporine can increase LDL cholesterol. If used without a clear indication, they should be stopped, or an alternative medication should be considered if available.
Which medications can increase triglycerides, and what should be done if they are used without a clear indication?
Bile acid sequestrants, beta blockers (except for carvedilol), estrogen, glucocorticoids, anabolic steroids, and protease inhibitors can increase triglycerides. If used without a clear indication, they should be stopped, or alternative medications should be considered if available.
What co-morbidities can increase LDL cholesterol or triglycerides, and how should they be managed?
Co-morbidities such as hypothyroidism and diabetes, which can increase LDL cholesterol or triglycerides, should be evaluated and better controlled as part of the management of hyperlipidemia.
What are the two main categories of lipid-lowering therapies?
lifestyle
pharmacological therapies
What are the components of lifestyle therapies for managing lipid levels?
- maintaining a healthy diet
- engaging in regular physical activity
- controlling body weight.
How can pharmacological lipid-lowering therapies be categorized based on their primary targets?
divided into two groups:
1. those that primarily lower LDL cholesterol
2. those that mainly reduce triglycerides.
Which medications are primarily used to lower LDL cholesterol levels?
- statins, ezetimibe, bempedoic acid, bile acid sequestrants, PCSK9 inhibitors, and inclisiran are primarily used to lower LDL cholesterol.
Which medications are mainly used to reduce triglyceride levels?
Fibrates, omega-3 fatty acids, icosapent ethyl, and niacin are primarily used to reduce triglycerides.
Why are lifestyle therapies considered crucial in any lipid-lowering treatment regimen, even when a patient takes medication?
Lifestyle therapies are essential because, even with medication, if a patient consumes a diet high in saturated fats, the medication’s effectiveness may be limited.
What are the key dietary recommendations for a patient aiming to lower their lipid levels?
Patients should consume a diet high in vegetables, fruits, whole grains, legumes, low-fat dairy products, low-fat poultry, fish, seafood, and nuts. They should limit or avoid tropical vegetable oils high in saturated fats and reduce intake of sweets, sugar-sweetened beverages, and red meats. In the case of hypertriglyceridemia, a very low-fat diet should be implemented, avoiding refined carbohydrates and alcohol.
How should a patient engage in physical activity to benefit their lipid levels, and how often should they do this?
Patients should participate in aerobic physical activity with moderate to vigorous intensity for 3-4 sessions per week, with each session lasting about 40 minutes to help manage their lipid levels.
What is the priority when considering pharmacological lipid-lowering therapies, and under what conditions might another approach be prioritized?
Lowering LDL cholesterol is the priority, but in the case of severe hypertriglyceridemia (defined as triglycerides ≥ 500), a focus on lowering triglycerides may be needed.
Why is it important to choose medications that have been shown to reduce the risk of ASCVD in lipid-lowering therapy?
The main goal of lipid-lowering therapy is to reduce the risk of ASCVD, and not all lipid-lowering medications have been consistently shown to achieve this in clinical trials.
Which lipid-lowering medication has the strongest evidence for reducing the risk of ASCVD and should be used first?
Statins have the strongest evidence for reducing the risk of ASCVD and should be the first choice for lipid-lowering therapy.
Which medications can be considered for use alongside statins if statin monotherapy does not achieve adequate responses?
If statin monotherapy does not result in adequate responses, medications that have been shown to reduce the ASCVD risk when added to a statin, such as ezetimibe, PCSK9 inhibitors, and icosapent ethyl, can be considered.
When might a patient need a medication that primarily lowers triglycerides, and what are some examples of such medications?
Patients with severe hypertriglyceridemia may be at an increased risk of pancreatitis and may need medications that primarily lower triglycerides, such as fibrates and omega-3 fatty acids.
Why is increasing HDL cholesterol with medication not typically chosen in lipid-lowering therapy?
Increasing HDL cholesterol with medication is not chosen because studies have not consistently shown that it reduces the risk of ASCVD.
Why is it important to be familiar with the expected percent reduction in LDL cholesterol and triglycerides by lipid-lowering medications?
Understanding the percent reduction in LDL cholesterol or triglycerides helps assess the effectiveness of lipid-lowering medications.
What is the typical range of LDL cholesterol reduction achieved by statins, and which statins can also lower triglycerides significantly?
Statins can reduce LDL cholesterol by 20-55%, with some statins like atorvastatin and rosuvastatin lowering triglycerides by about 30%. These statins can be used to treat severe hypertriglyceridemia.
How much can medications like ezetimibe, bempedoic acid, and bile acid sequestrants (BAS) lower LDL cholesterol?
by approximately 20%.
What important consideration should be made when using BAS to lower LDL cholesterol?
BAS can increase triglycerides and are contraindicated if triglycerides are over 300.
How much can PCSK9 inhibitors reduce LDL cholesterol levels?
by more than 50%.
What is the typical range of triglycerides reduction achieved by medications like fibrates, omega-3 fatty acids, and niacin?
These medications can lower triglycerides by 20-50%.
How much do purified omega-3 fatty acids, like icosapent ethyl, typically lower triglycerides?
by about 20%.
