Dyslipidemia

Question 1

Which lab values should be collected?

Answer 1

-Full lipid panel
-baseline LDL
-changes in LDL: 4 to 12 weeks after taking Rx -> determine % reduction

Question 2

What is the recommended timeframe to check the baseline LDL?

Answer 2

for adults from the age of 20: every 4-6 years

Question 3

How is the efficacy of a lipid-lowering therapy assessed?

Answer 3

-monitor the LDL reduction in % during therapy
-high intense therapy should lower LDL by 50%

Question 4

What does a Full Lipid Panel consist of?

Answer 4

-Total Cholesterol (TC)
-Triglycerides (TG)
-High-density lipoprotein (HDL) (good)
-Low-density lipoprotein (LDL) (bad bc it contributes to plaque formation)

Question 5

Why is HDL considered good cholesterol?

Answer 5

scavenges the arteries and veins and removes cholesterol -> returning it to the liver

Question 6

What is cholesterol needed for in the body?

Answer 6

-cell membranes
-production of hormones (testosterone, estrogenes, aldosterone)
-vitamin D
-bile acid production

Question 7

Role of Triglycerides

Answer 7

-Source of energy when someone has not eaten (between meals)

Question 8

Why are liver function tests LFT performed on patients considered for Statins therapy?

Answer 8

-Statins work on the liver (HMG-CoA-Reductase)
-patients with a damaged liver are not the best candidates for statins
-Statins may even damage the liver
-LFTs are usually measured every year for patients on statins

Question 9

Why are SCr and TSH levels checked in patients considered for statins?

Answer 9

to screen for risks of Statin-induced myalgia (SAM)
-patients with bad kidney can still use statins, but it increases the risk of having myalgia as a side effect

Question 10

Why are Creatinine Phosphokinase (CPK) levels checked in patients considered for statins?

Answer 10

-blood marker that indicates muscle damage (CPK leaks into the blood when a muscle is damaged)

-patients experiencing severe muscle damage due to statins, their CPK is high

-CPK measurements are not as common, and will be performed if the patient complains about muscle pain -> to rule out it is due to statins

Q: is CPK

Question 11

Forms of ASCVD (Arteriosclerosis Cardiovascular Disease)

Answer 11

-Acute coronary syndrome (heart attack)
-MI
-Angina
-Stroke or TIA
-PAD (Peripheral arterial disease)
-Revascularization (stent)

Question 12

Genetic conditions of Dyslipidemia

Answer 12

-Homozygous familial hypercholesterolemia (HoFH, 1 gene)

-Heterozygous familial hypercholesterolemia (HeFH, 2 genes)

-gene responsible for clearing (metabolism) of cholesterol in the blood

Question 13

What is the Coronary Artery Calcium (CAC) Score?

Answer 13

-CT scan measuring the amount of calcified plaque in the coronary arteries

the higher the score
-the more the calcification
-the less dynamic and flexible the blood vessels are

-for patients on intermediate risk for coronary artery disease, not for low-risk or ASCVD (already in therapy) patients

Question 14

Cholesterol LDL levels

Answer 14

<100 mg/dl … desirable
100-129 mg/dl … above desirable
130-159 mg/dl … Borderline high
160-189 mg/dl … High
>190 mg/dl … Very high

Question 15

Cholesterol HDL levels

Answer 15

HDL
for men: <40 mg/dl … too low
for women <50 mg/dl …. too low

lifestyle change is the best way to boost HDL (diet, exercise)

Question 16

Triglycerides

Answer 16

<150 mg/dl … normal
150-199 mg/dl … Borderline high
200-499 mg/dl … high
>500 mg/dl … very high

Question 17

Q

Answer 17

which meds reduce which cholesterol?
does lifestyle change total cholesterol or one specific type
-does the reduction of % in lifestyle change and taking meds add up

Question 18

Drugs targeting LDL

Answer 18

-Statins (lower by 30-50% or >50%)
-Ezetimibe (lower 20-25%)
-PCSK-9 (lower by >50%)
-Bile Acid Sequestrant (20-25%)
-Bempedoic Acid (Nexletol, 20-25%)
-Inclisiran (about 50%)

Question 19

LDL drugs with an efficacy of about 50%

Answer 19

Statins: 30-50% or >50%
PCSK-9: >50%
Inclisiran (siRNA blocking PCSK-9): >50%

Question 20

LDL drugs with an efficacy of about 25%

Answer 20

Ezetimibe: 20-25%
Bile Acid Sequestrant: 20-25%
Bempedoic Acid: 20-25%

Question 21

What are Bile acid sequestrants often used for off-label?

Answer 21

-often used in diarrhea bc they are strongly constipating drugs
-actually not often used for dyslipidemia bc of the constipation side effect
-cholestyramine, colesevelam, colestipol

Question 22

What is the number 1 target in lipid therapy?

Answer 22

1. LDL
2. triglycerides: when >500 mg/dl

HDL is per se not a target

Question 23

Which disease can be caused by elevated Triglycerides?

Answer 23

Pancreatitis

Question 24

Drugs targeting Triglycerides

Answer 24

Fibrates
Omega-3-FA
Niacin
they lower TG by 30-50%

Question 25

What are the high-risk conditions to look out for?

Answer 25

-ASCVD
-Diabetes
-LDL >190 mg/dl