Dyslipidemia Flashcards
HLD Risk Factors:
Primary/Hereditary:
Familial _______ (FH)
______ vs______ (can come from mom or both parents)
often presents as a patient with extremely high ____ or ___ _____ found/dx at a _____
age
- Familial hypercholesterolemia (FH)
Heterozygous vs Homozygous (can come from mom or both parents) - often presents as a patient with extremely high LDLs or total cholesterol found/dx at a younger
age
HLD Risk Factors:
Secondary/Acquired: “The 4D Classification”
1.
2.
3.
4.
- DIET: high saturated fat foods, ALCOHOL, smoking
- DRUGS: atypical antipsychotics, glucocorticoids, estrogen/progestin, tacrolimus,
cyclosporine, mirtazapine (monitor cholesterol panel while patient is on these meds) - DISORDERS: nephrotic syndrome, renal failure, biliary obstruction, pregnancy, advanced age
- DISEASES: hypothyroidism, obesity, PCOS, DM, HTN, liver disease, CKD
Diet that increases risk of HLD (3)
high saturated fat foods
ALCOHOL
smoking
Drugs that increases risk of HLD (6)
DRUGS:
1. atypical antipsychotics**
2. glucocorticoids**
3. estrogen/progestin
4. tacrolimus,
5. cyclosporine
6. mirtazapine
(monitor cholesterol panel while patient is on these meds)
Disorders that increases risk of HLD (5)
- nephrotic syndrome
- renal failure
- biliary obstruction
- pregnancy
- advanced age
Diseases that increases risk of HLD (7)
DISEASES:
1. hypothyroidism
2. obesity
3. PCOS
4. DM
5. HTN
6. liver disease
7. CKD
Definition of HLD:
TC > _____
LDLs > 160
TC > 200
LDLs > 160
Complication of HLD:
____ is the leading cause of morbidity & mortality
Complications: ASCVD is the leading cause of morbidity & mortality
High cholesterol → Coronary atherosclerosis → ASCVD = Atherosclerotic Cardiovascular Disease (IMPORTANT TO MEMORIZE)
ACS: MI/Unstable and Stable Angina
Coronary/arterial revascularization
Stroke/TIA
Peripheral artery disease (PAD)
ASCVD encompasses (4):
1. MI/____ and _____ angina
2. ______ revascularization
3. ____/TIA
4. ______ ______ disease (PAD)
ACS: MI/Unstable and Stable Angina
Coronary/arterial revascularization
Stroke/TIA
Peripheral artery disease (PAD)
ASCVD Risk Calculator used to estimate risk/likelihood of having an event in the next ____yrs
ASCVD Risk Calculator used to estimate risk determines likelihood of having an event in the next 10yrs
Determine which patients qualify for lipid-lowering medications
4 statin benefit groups:
1. Clinical ________ (secondary prevention)
2. Severe hypercholesterolemia (LDL > ___ mg/dL)
3. Age 40-75 yo with _____ + LDL 70 -____ mg/dL
4. Age 40-75 yo w/out ___ + LDL 70 - _____ mg/dL + ASCVD risk > ______%
- Clinical ASCVD (secondary prevention)
- Severe hypercholesterolemia (LDL > 190 mg/dL)
- Age 40-75 yo with DM + LDL 70-189mg/dL
- Age 40-75 yo w/out DM + LDL 70-189mg/dL + ASCVD risk >7.5%
Treatment for HLD
Treatment: Lifestyle modifications + Statin
Know the Statin Intensities:
- Low intensity statin = LDL lowering < _____ (only used to see if a patient can tolerate any dose of a statin)
- Moderate intensity statin = LDL lowering ___-___%
- High intensity statin = LDL lowering > ____% (memory these + the doses)
Know the Statin Intensities:
- Low intensity statin = LDL lowering <30% (only used to see if a patient can tolerate any dose of a statin)
- Moderate intensity statin = LDL lowering 30-49%
- High intensity statin = LDL lowering >50% (memory these + the doses)
High intensity statins (2):
- Atorvastatin
- Rosuvastatin
High intensity statin dosages:
- Atorvastatin 40-80mg
- Rosuvastatin 20-40mg
EXTRA INFO: STATINS Pharmacokinetics
Shorter half-life: take at _____;
Longer half-time: works ______ the ___; (Remember most cholesterol made at _____)
Shorter half-life: take at night;
Longer half-time: works throughout the day; (Remember most cholesterol made at night)
Solubility: Lipophilic (has ____ side effects - gets into different tissues)
Hydrophilic: ____ widely distributed (____ s/e)
Solubility: Lipophilic (has more side effects - gets into different tissues)
Hydrophilic: less widely distributed (less s/e)
Atorvastatin (Lipitor) is ___philic and has ____ side effects!
Atorvastatin (Lipitor) is LIPOphilic and has MORE side effects (risk of myalgias)!
Rosuvastatin is ____philic and has ____ side effects
Rosuvastatin is HYDROphilic and has LESS side effects
Monitoring of Statins:
Baseline _____ panel & ____s (drug-induced liver dysfunction);
Monitor lipid panel __-___ weeks after INITIATION or CHANGE IN DOSE;
Once stable, check lipid panel every _-___ months;
Monitoring of Statins:
Baseline lipid panel & LFTs (drug-induced liver dysfunction);
Monitor lipid panel 4-12 weeks after INITIATION or CHANGE IN DOSE;
Once stable, check lipid panel every 3-12 months;
Safety:
typically well-tolerated & safe
s/e: ______ (rare cases of _______)
Only check ___ (IF muscle pain/weakness present)
Safety:
typically well-tolerated & safe
s/e: myalgias (rare cases of rhabdomyolysis)
Only check CK (IF muscle pain/weakness present)
Statin Intolerance: defined as __-__ statins tried and one at its _____ dose.
Statin Intolerance: defined as 2-3 statins tried and one at its lowest dose.
STATIN INTOLERANCE: BENEFIT > SIDE EFFECTS (MUSCLE PAINS)
Modifications for patient intolerance (?)
Modifications: Adjust dose or try a different statin;
STATIN INTOLERANCE: BENEFIT > SIDE EFFECTS (MUSCLE PAINS)
What other medication can you try besides a statin?
_______: lowers LDL 50-60% has heart (CV) benefits;
usu. for patients w/ very high _____ as add-on OR for patient who can’t tolerate _____;
No _______
CONS: _______ & a _____ _______ q2-4 weeks
What other medication can you try besides a statin?
PCSK9i: lowers LDL 50-60% has heart (CV) benefits;
usu. for patients w/ very high LDLs as add-on OR for patient who can’t tolerate statins;
No MYALGIAS
CONS: expensive & a subq injection q2-4 weeks
Define 1st statin benefit group & type of prevention
has an ASCVD event (VERY high risk vs high risk for 2nd event)
secondary prevention
Goals of therapy for 1st statin benefit group (Clinical ASCVD)
- Type of statin
- Very high risk LDL goal
- Not very high risk LDL goal
- High intensity statin unless > 75 yo (more likely to have myalgias)
- Very high risk: (> 2 ASCVD events or 1 event + 2 high conditions)
Goal: LDL reduction by > 50% less than 55 mg/dL on MAX STATIN therapy - Not very high risk: LDL less than 70 mg/dL
Goal for very high risk: LDL reduction by __ % and LDL less than ___ mg/dL on MAX STATIN therapy
Very high risk: (> 2 ASCVD events or 1 event + 2 high conditions)
Goal: LDL reduction by > 50% less than 55 mg/dL on MAX STATIN therapy
Goal for not very high risk: LDL less than ___ mg/dL
Not very high risk: LDL less than 70 mg/dL
Define 2nd statin benefit group:
Age ___ to ___ yo
Type of prevention
LDL >/= ____ mg/dL
2nd statin benefit group:
Age 20 to 75 yo
Primary prevention LDL >/= 190 mg/dL
2nd statin benefit group goal of therapy:
Type of statin
LDL goal
High intensity statin
LDL reduction of 50% reduction or LDL < 100 mg/dL
Define 3rd statin benefit group:
Age ___ to ___ yo
LDL ___ to ___ mg/dL
_____ disorder
3rd statin benefit group:
Age 40-75 yo + LDL 70-189mg/dL + DM
3rd statin benefit group goals of therapy:
Type of statin
IF ASCVD risk > 7.5% requires ____ intensity statin
Goal LDL: ___% reduction + LDL < ___ mg/dL
IF ASCVD > 20%, Goal LDL < ____ mg/dL
consider adding ____ if statin doesn’t meet goal
3rd statin benefit group goals of therapy:
Moderate intensity statin
IF ASCVD risk > 7.5 % → HIGH INTENSITY STATIN
Goal: 50% reduction + LDL < 100
IF ASCVD > 20%, GOAL LDL < 70 mg/dL
consider adding ezetimibe if statin doesn’t meet goal
Define 4th statin benefit group:
age ___ to ___ yo
LDL ___ to ____ mg/dL w/o ____
Define 4th statin benefit group:
age 40 to 75 yo
LDL 70 to 189 mg/dL w/o DM
Goals of therapy for the 4th statin benefit group depends on _____ risk
Goals of therapy for the 4th statin benefit group depends on ASCVD risk
Only treat hypertriglyceridemia if fasting TG >/= _____ mg/dL
Hypertriglyceridemia: Only treat if fasting TG > /= 500 mg/dL
treatment for TG
treatment for TG
Key takeaways
Conside FH in which benefit group?
2nd statin benefit group LDL > 190mg/dL
