Dyslipidemia

Question 1

What percentage of death in men >65 y.o is attributed to CHD?

Answer 1

50%

Question 2

What percentage of death in women >65 y.o. is attributed to CHD?

Answer 2

56%

Question 3

Discuss the relationship of serum cholesterol levels to the risk of developing CHD.

Answer 3

They are directly proportional; the higher the serum cholesterol levels, the higher the risk of developing CHD.

Question 4

What can cause your risk for hyperlipidemia to increase?

Answer 4

1. Family history (genetics)
2. Male >= 45, Female >= 55
3. Diabetes Mellitus
4. HTN
5. diet
6. exercise level
7. Smoking

Question 5

Values of Total Cholesterol

Answer 5

< 200 = Desirable

200-239 = Borderline High

> 240 = High

Question 6

Values of LDL Cholesterol

Answer 6

< 100 = optimal

100-129 = near or above optimal

130-159 = borderline high

160-189 = high

> 190 = very high

Question 7

Values of HDL Cholesterol

Answer 7

< 40 = Low

> 60 = High

Question 8

Values of Triglycerides

Answer 8

< 150 = Normal

150-199 = Borderline High

200-499 = High

> 500 = Very High

Question 9

Primary Prevention of Hyperlipidemia

Answer 9

measures targeted to prevent the onset of hyperlipidemia

Question 10

Secondary Prevention of Hyperlipidemia

Answer 10

Identify and treat asymptomatic persons who have hyperlipidemia.

Question 11

Tertiary Prevention of Hyperlipidemia

Answer 11

Minimize the effect of atheroslerosis to prevent disability and prevent complications.

Question 12

Describe the patient population that has a greater risk for hyperlipidemia?

Answer 12

Patients with:

• clinical ASCVD
• LDL >= 189 mg/dL
• diabetes (but without clinical ASCVD) and LDL at 70-189 mg/dL at age 40-75 years
• LDL at 70-189 mg/dL with an estimated 10-yr risk of ASCVD of 7.5% or higher but without clinical ASCVD or diabetes

Question 13

What does a calculated risk of 7.5% mean per ACC/AHA guidlines (the ramifications to those at increased risk for hyperlipidemia)?

Answer 13

A 10-year risk of 7.5% means that 7.5 out of 100 people with the same predisposing factors will develop atherosclerotic cardiovascular disease.

Question 14

Atherosclerosis Pathophysiology

Answer 14

• LDL in bloodstream invades blood vessel’s endothelium
• LDL then accumulates in tunica intima
• LDL is then oxidized
• Macrophages phagocytosize oxidized LDL creating foam cells
• Foam cells form fatty streak
• collagen migrates over fatty streak, forming a fibrous plaque - rupture- platelet aggregation - thrombin generation-fibrin formation- thrombus and occlusion

Question 15

According to NCEP, what are the major risk factors for CHD?

Answer 15

Current cigarette smoking

Hypertension (BP ≥ 140/90) or on antihypertensive medication

Low HDL (<40mg/dL)

FH of premature CHD (definite MI or sudden death) 1° male relative < 55 y/o, 1° female relative < 65 y/o

Age and Gender (male ≥ 45 y/o and female ≥ 55 y/o)

Question 16

C-reactive protein (CRP) is a marker for what?

Answer 16

inflammation

(the higher the level of CRP, the higher the systemic inflammation and the higher risk for rupture of plaques built up in vessels)

Question 17

What are the serum levels of CRP and related risk for rupture of vascular plaques?

Answer 17

serum level risk

 \< 1 mg/l      good

 1-3 mg/l     moderate

 \> 3 mg/l     high risk

Question 18

Reason to initiate a high intensity statin therapy (Atorvastatin 80mg qd)

Answer 18

secondary prevention in adults >75

primary prevention in adults with LDLs > 190

primary prevention in adults 40-75 with LDLs 70-189 and estimated 10 yr risk >7.5%

primary prevention in pts with DM age 40-75 with LDLs 70-189 and estimated 10 risk >7.5%

Question 19

Reason to initiate Bile Acid Resin or Nicotinic Acid therapy

Answer 19

When LDL needs lowering, can begin with a BAR/Nictotinic Acid and then f/u 6 wks later to determine if tx is working

or

If start with a statin and LDL is not lowered enough at f/u, consider adding a BAR/nicotinic acid