Dyslipidemia Flashcards
Dr. Hess
Which lab values should be collected?
-Full lipid panel
-baseline LDL
-changes in LDL: 4 to 12 weeks after taking Rx -> determine % reduction
What is the recommended timeframe to check the baseline LDL?
for adults from the age of 20: every 4-6 years
How is the efficacy of a lipid-lowering therapy assessed?
-monitor the LDL reduction in % during therapy
-high intense therapy should lower LDL by 50%
What does a Full Lipid Panel consist of?
-Total Cholesterol (TC)
-Triglycerides (TG)
-High-density lipoprotein (HDL) (good)
-Low-density lipoprotein (LDL) (bad bc it contributes to plaque formation)
Why is HDL considered good cholesterol?
scavenges the arteries and veins and removes cholesterol -> returning it to the liver
What is cholesterol needed for in the body?
-cell membranes
-production of hormones (testosterone, estrogenes, aldosterone)
-vitamin D
-bile acid production
Role of Triglycerides
-Source of energy when someone has not eaten (between meals)
Why are liver function tests LFT performed on patients considered for Statins therapy?
-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
Why are SCr and TSH levels checked in patients considered for statins?
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
Why are Creatinine Phosphokinase (CPK) levels checked in patients considered for statins?
-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
Forms of ASCVD (Arteriosclerosis Cardiovascular Disease)
-Acute coronary syndrome (heart attack)
-MI
-Angina
-Stroke or TIA
-PAD (Peripheral arterial disease)
-Revascularization (stent)
Genetic conditions of Dyslipidemia
-Homozygous familial hypercholesterolemia (HoFH, 1 gene)
-Heterozygous familial hypercholesterolemia (HeFH, 2 genes)
-gene responsible for clearing (metabolism) of cholesterol in the blood
What is the Coronary Artery Calcium (CAC) Score?
-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
Cholesterol LDL levels
<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
Cholesterol HDL levels
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)
Triglycerides
<150 mg/dl … normal
150-199 mg/dl … Borderline high
200-499 mg/dl … high
>500 mg/dl … very high
Q
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
Drugs targeting LDL
-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%)
LDL drugs with an efficacy of about 50%
Statins: 30-50% or >50%
PCSK-9: >50%
Inclisiran (siRNA blocking PCSK-9): >50%
LDL drugs with an efficacy of about 25%
Ezetimibe: 20-25%
Bile Acid Sequestrant: 20-25%
Bempedoic Acid: 20-25%
What are Bile acid sequestrants often used for off-label?
-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
What is the number 1 target in lipid therapy?
- LDL
- triglycerides: when >500 mg/dl
HDL is per se not a target
Which disease can be caused by elevated Triglycerides?
Pancreatitis
Drugs targeting Triglycerides
Fibrates
Omega-3-FA
Niacin
they lower TG by 30-50%
What are the high-risk conditions to look out for?
-ASCVD
-Diabetes
-LDL >190 mg/dl
