Dyslipidemia Flashcards
A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL (6.47 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L), and triglycerides 180 mg/dL (2.03 mmol/L).
- What is this patient’s non-HDL cholesterol and LDL cholesterol?
A. 184 mg/dL (4.76 mmol/L) and 154 mg/dL (3.98 mmol/L)
B. 206 mg/dL (5.33 mmol/L) and 170 mg/dL (4.40 mmol/L)
C. 214 mg/dL (5.53 mmol/L) and 185 mg/dL (4.78 mmol/L)
D. 236 mg/dL (6.10 mmol/L) and 202 mg/dL (5.22 mmol/L)
Answer: B
Option B: Correct. The calculation for non-HDL cholesterol is total cholesterol – HDL cholesterol (250 – 44 = 206) or (6.47 – 1.14 = ~5.33). The calculation for LDL cholesterol is total cholesterol – (HDL cholesterol + triglycerides/5) (250 – [44 + 180/5] = 170) or total cholesterol – (HDL cholesterol + triglycerides/2.2) (6.47 – (1.14 + 2.03/2.2) = ~4.40).
A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL (6.47 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L), and triglycerides 180 mg/dL (2.03 mmol/L).
What is this patient’s primary target for intervention?
A. Triglycerides and non-HDL cholesterol
B. VLDL cholesterol and HDL cholesterol
C. HDL cholesterol and LDL cholesterol
D. Non-HDL and LDL cholesterol
Option D: Correct. Both non-HDL cholesterol and LDL cholesterol are considered primary cholesterol targets by the NLA, AACE/ACE, and ACC guidelines and should both be targeted in this patient.
A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL (6.47 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L), and triglycerides 180 mg/dL (2.03 mmol/L).
Based on the ACC/AHA guidelines, which statin benefit group does the patient fall into?
A. Between 40 and 75 years of age with an LDL cholesterol greater than 190 mg/dL (4.91 mmol/L)
B. Between 40 and 75 years old with diabetes and an LDL cholesterol between 70 and 189 mg/dL (1.81–4.89 mmol/L)
C. Established clinical ASCVD
D. Between 40 and 75 years old with diabetes and an LDL cholesterol greater than 190 mg/dL (4.91 mmol/L)
Option B: Correct. The patient has type 2 diabetes and falls in the age range of 40 to 75 years of age with LDL cholesterol between 70 and 189 mg/dL (1.81–4.89 mmol/L).
A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL (6.47 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L), and triglycerides 180 mg/dL (2.03 mmol/L).
According to the ACC/AHA guidelines, what intervention would be most appropriate for this patient?
A. Start atorvastatin 40 mg daily
B. Start colesevelam 3.75 gm daily
C. Start fenofibrate 145 mg daily
D. Start simvastatin 10 mg daily
Answer: A
Option A: Correct. The patient is indicated for a moderate to high-intensity statin based on having type 2 diabetes mellitus and being between 40 and 75 years of age. Therefore, atorvastatin is the best answer because a dose of 40 mg is a high-intensity dose.
A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL (6.47 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L), and triglycerides 180 mg/dL (2.03 mmol/L).
The patient returns to clinic 6 months after his last visit. He reports he had an ischemic stroke related to high blood pressure about 3 months ago. His lipid panel is as follows today: total cholesterol 180 mg/dL (4.65 mmol/L); triglycerides 100 mg/dL (1.13 mmol/L); HDL cholesterol 40 mg/dL (1.03 mmol/L); LDL cholesterol 120 mg/dL (3.10 mmol/L). He has been taking rosuvastatin 10 mg daily for the last 6 months. According to the ACC/AHA guidelines, what is the next step to optimize this patient’s cholesterol and lower his risk of future CV events?
A. Change his rosuvastatin to simvastatin 80 mg daily
B. Change his rosuvastatin to atorvastatin 20 mg daily
C. Increase his rosuvastatin to 40 mg daily
D. Add ezetimibe 10 mg daily
Option C: Correct. The patient is indicated for a high-intensity statin based on the recent stroke which is a form of clinical ASCVD. Rosuvastatin 40 mg is the only high-intensity statin dose listed that is recommended to prescribe.
A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL (6.47 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L), and triglycerides 180 mg/dL (2.03 mmol/L).
If the patient returns and remains above his non-HDL and LDL cholesterol goals after taking a maximum tolerated statin, what is the next option recommended for him by the ACC Expert Consensus Decision Pathway?
A. Lomitapide 5 mg daily
B. Colesevelam 3.75 gm daily
C. Ezetimibe 10 mg daily
D. Mipomersen 200 mg subcutaneously every week
Option C: Correct. If the patient remains above his non-HDL cholesterol goal and LDL cholesterol goal on maximum tolerated statin then he is indicated for ezetimibe as a first line option to add to the statin therapy for further cholesterol lowering.
Which side effect can be caused by niacin therapy?
A. Hypertension
B. Hypothyroidism
C. Gout
D. Renal failure
Answer: C
Option A: Incorrect. Niacin is not associated with causing hypertension, but can cause hypotension.
Option B: Incorrect. Niacin is not associated with causing hypothyroidism.
Option C: Correct. Niacin is associated with increasing uric acid levels which can result in a gout attack.
Option D: Incorrect. Niacin is not associated with causing renal failure.
According to the AACE/ACE guidelines, which risk category does a patient with stage 4 chronic kidney disease and hypertension and no other comorbidities or cardiovascular risk factors best fit?
A. Very High Risk
B. High Risk
C. Moderate Risk
D. Low Risk
Answer: A
Option A: Correct. This patient is considered very high risk based on having chronic kidney disease (stage 3 or 4) with at least one additional cardiovascular risk factor (hypertension).
Which of the following is a secondary cause of dyslipidemia?
A. Hypertension
B. Hyperthyroidism
C. GERD
D. Atypical antipsychotics
Option D: Correct. Atypical antipsychotics are known to be secondary causes of dyslipidemia.
Choose the patient scenario below that meets the FDA approved indication for alirocumab as a lipid lowering therapy.
A. 40-year-old female with heterozygous familial hypercholesterolemia (HeFH) taking atorvastatin 80 mg daily with an LDL cholesterol of 50 mg/dL (1.29 mmol/L)
B. 50-year-old female with hypertension and type 2 diabetes mellitus taking simvastatin 20 mg daily with an LDL cholesterol of 70 mg/dL (1.81 mmol/L)
C. 40-year-old male with heterozygous familial hypercholesterolemia (HeFH) receiving atorvastatin 80 mg daily with an LDL cholesterol of 120 mg/dL (3.10 mmol/L)
D. 70-year-old male with heterozygous familial hypercholesterolemia (HeFH) receiving atorvastatin 20 mg daily with an LDL cholesterol of 140 mg/dL (3.62 mmol/L)
Option C: Correct. The FDA approved indication for alirocumab is for patients with heterozygous familial hypercholesterolemia on maximum tolerated statin not achieving optimal LDL cholesterol. This patient is on maximum dose atorvastatin and still has elevated LDL cholesterol making this the best answer.
A 46-year-old male with a history of dyslipidemia and hypertension is taking atorvastatin 40 mg daily (started 1 year ago). His lipid values today are non-HDL cholesterol 156 mg/dL (4.03 mmol/L) and LDL cholesterol 110 mg/dL (2.84 mmol/L). His ASCVD risk score prior to starting atorvastatin was 9%. The patient complains of muscle pain and weakness today with a creatine kinase of 120 U/L (2.0 µkat/L). What would be the most appropriate intervention?
A. Continue current therapy and monitor his progress
B. Decrease his atorvastatin dose to 20 mg daily and monitor his progress
C. Add fenofibrate 145 mg daily
D. Add niacin ER 500 mg at bedtime
Option B: Correct. Based on the patient’s CK not being greater than 3 times the ULN it is appropriate to dose reduce the statin and see if the muscle symptoms resolve.
A 54-year-old female with a history of type 2 diabetes mellitus and hypothyroidism is coming in today for her annual follow-up. Her lipid values today are total cholesterol 196 mg/dL (5.07 mmol/L), HDL cholesterol 44 mg/dL (1.14 mmol/L) and LDL cholesterol 100 mg/dL (2.59 mmol/L). She has an ASCVD risk score of 10%. Does the patient fit into a statin benefit group and if so what is the best recommended therapy for her based on ACC/AHA guidelines?
A. No and she should not start any pharmacotherapy for her lipids
B. No and she should start on a moderate-intensity statin
C. Yes and she should start on a moderate-intensity statin
D. Yes and she should start on a high-intensity statin
Option D: Correct. The patient is in the statin benefit group secondary to having type 2 diabetes mellitus and being between 40 and 75 years of age. She is indicated for high-intensity statin therapy because her ASCVD risk score is greater than 7.5%.
A 48-year-old male has had hypertension and dyslipidemia for the last 5 years. His lipid values today are total cholesterol 220 mg/dL (5.69 mmol/L), HDL cholesterol 40 mg/dL (1.03 mmol/L) and LDL cholesterol 130 mg/dL (3.36 mmol/L). He has an ASCVD risk score of 6%. He consumes a low fat diet and performs moderate level exercise 30 minutes a day, 5 days a week. He has a body mass index of 28.0 kg/m2. Which of the following are guideline recommended non-pharmacotherapy changes to improve his cholesterol?
A. Aim for 10% of calories from saturated fat
B. Maintain a body mass index of less than 25.0 kg/m2
C. Increase fiber to 50 gm/day
D. Decrease exercise to 120 minutes of moderate to high-intensity exercise per week
Option B: Correct. The guidelines recommend maintaining a normal weight which is a body mass index less than 25.0 kg/m2.
Which type of therapy would be most appropriate for a 40-year-old woman with stage 4 chronic kidney disease and hypertension with a total cholesterol 190 mg/dL (4.91 mmol/L), HDL cholesterol 50 mg/dL (1.29 mmol/L), and triglycerides 550 mg/dL (6.22 mmol/L)?
A. Atorvastatin 80 mg daily
B. Colestipol 2 gm daily
C. Epanova 4 gm daily
D. Gemfibrozil 600 mg once daily
Option C: Correct. The patient is in need of treatment for her high triglycerides since they are over 500 mg/dL (5.65 mmol/L). The best option is Epanova as the patient is contraindicated to gemfibrozil based on renal function, colestipol could increase the patient’s triglycerides, and atorvastatin will not lower triglycerides to the same degree as high dose omega 3 fatty acids.
A 60-year-old male recently suffered a myocardial infarction and has a history of hypertension. He reports he has never been on a cholesterol lowering medication before. His lipid values yesterday were total cholesterol 170 mg/dL (4.39 mmol/L), HDL cholesterol 46 mg/dL (1.19 mmol/L), and LDL cholesterol 96 mg/dL (2.48 mmol/L). He has an ASCVD risk score of 7.5%. What is the recommended lipid lowering therapy for this patient based on ACC/AHA guidelines?
A. His lipids are controlled and he does not need treatment
B. He should be placed on simvastatin 80 mg daily
C. He should be placed on atorvastatin 80 mg daily
D. He should be placed on ezetimibe 10 mg daily
Option C: Correct. The patient meets the definition of clinical ASCVD secondary to his new myocardial infarction and should be placed on a high-intensity statin (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg daily).
