Dyslipidemia Flashcards
In addition to lowering LDL-C levels, statins also: A. Improve endothelial function B. Decrease platelet aggregation C. Reduce inflammation D. Reduce HDL levels E. All of the above
A. Improve endothelial function
B. Decrease platelet aggregation
C. Reduce inflammation
A 59-year-old man in good health with no evidence of cardiovascular disease, a BMI of 29, an HbA1c of 5.9, and an LDL-C of 167 mg/dL asks whether he should be taking a statin. You could tell him that:
A. Statins are only approved for use in patients with documented cardiovascular disease (CVD)
B. Statins have no demonstrated benefit in patients without CVD
C. Statins can reduce the incidence of cardiovascular events in patients without CVD
D. Statins may increase the risk of developing diabetes
C. Statins can reduce the incidence of cardiovascular events in patients without CVD
D. Statins may increase the risk of developing diabetes, but—–that risk is outweighed by the benefits a statin may have for him
According to one meta-analysis, each additional 1mmol/L reduction in LDL-C is associated with a reduction in the incidence of major vascular events of: A. 5% B. 10% C. 20% D. 30%
C. 20%
Statins have been reported to: A. Increase the risk of hemorrhagic stroke B. Reduce the risk of overall stroke C. Reduce all-cause mortality D. All of the above
D. All of the above
Which of the following statins is not metabolized to a clinically significant extent by CYP enzymes? A. Lovastatin B. Pravastatin C. Simvastatin D. Rosuvastatin E. Fluvastatin
B. Pravastatin
D. Rosuvastatin
Which of the following drugs has been shown to improve clinical outcomes when added to a statin?
A. Ezetimibe (cholesterol absorption inhibitor)
B. Alirocumab (PCSK9 inhibitor)
C. Gemfibrozil (fibrate)
D. Niacin
A. Ezetimibe (cholesterol absorption inhibitor)
A74-year-old man with a long history of coronary artery
disease has been taking atorvastatin 40 mg/day for many years. Now his LDL-C is 68, but he has seen advertisements for PCSK9 inhibitors and would like to take one in addition to atorvastatin. You could tell him that:
A. They are expensive
B. They are only approved for patients who require
additional lowering of LDL-C
C. They have not been shown to improve clinical outcomes
D. They must be administered by the subcutaneous route
E. All of the above
E. All of the above
Consumption of alcohol is associated with which lipid
changes?
- increased HDL
2. increased triglycerides
__, __, and ___ are NOT water soluble
cholesterol
cholesterol esters
triglycerides
What are secondary causes of dyslipidemia
- DM
- excessive alcohol intake
- glucocorticoid excess
- estrogen/OCP
- hypothyroidism
- obstructive liver disease
- BB/Thiazide diuretics
5-7: CHOL>TG
What dysplipidemia classification?
- Increased cholesterol production [familial combined]
- Decreased LDL catabolism [familial]
- Increases in dietary saturated fat and cholesterol can also result in increased LDL
hypercholesterolemia (over 85% is polygenic)
What dysplipidemia classification?
- Increased VLDL production [familial]
- Decreased triglyceride metabolism via lipoprotein lipase
hypertriglyceridemia
hypertriglyceridemia is defined as triglyceride levels of ___
200-500mg/dL
hypertriglyceridemia develops with:
- age
- weight gain
- obesity
- diabetes
HDL deficiency is defined by what levels?
Males: less than 40mg/dl
Females: less than 50mg/dl
What are causes of HDL deficiency?
- drugs: BB, diuretics, progestin, androgens, HIV protease inhibitors
- hypertriglyceridemic disorders
- sedentary lifestyle
- smoking
fatty streak is linked with ___
plaque disruption is linked with ____
inflammation
thrombus formation
antioxidants and statins proposed to prevent atherosclerosis by blocking what step?
- Oxidation of LDL apoB by arterial cells (mediated by oxidants such as O2, O2-NO
* statins may also act to affect plaque stability
describe the steps of the development of atherosclerotic plaque?
- Movement of excess LDL into subintimal space of arterial wall
- Oxidation of LDL apoB by arterial cells (mediated by oxidants such as O2-, O2– NO)
- Uptake of oxidized-LDL by macrophages → Formation of foam cells in arterial walls
- Foam cells accumulate → Cytokines from arterial walls → Attract monocytes and T cells
- Contribute to progressive early lesion → Growth factor release → Arterial smooth muscle proliferation → Lipid accumulation → Fibrosis → Atherosclerotic plaque
Hypercholesterolemia (increased LDL) is treated with what drugs?
- statins
- niacin
- bile acid sequestrands
- ezetimibe
- sterol.stnaol esters (in diet)
Hypertriglyceridemia is treated with what drugs?
- Fibric acid derivative
- niacin
- fish oil
- HMG CoA reductase inhbitors (Higher doses)
Low HDL is treated with what drugs?
- niacin
- fibrates
- HMG CoA reductase inhibitors
Describe the 1st step in managing cholesterol to reduce atherosclerotic CVD
- determine lipoprotien levels
LDL-C = Total Cholesterol − HDL-C − VLDL
*VLDL = Triglycerides ÷ 5 Iif TG less than 400)
___ is primary lipoprotein of “interest”
LDL-C
Describe the 2nd step in managing cholesterol to reduce atherosclerotic CVD
Determine presence of major CHD risk factors
-Estimate 10 year risk of coronary heart disease event by “Pooled Cohort Equation” (risk markers include sex, race, total cholesterol, HDL-C, BP, BP treatment status, diabetes, current smoking status)
What are the risk markers for CHD event by Pooled Cohort equation?
- sex (male)
- race (AA vs Caucasian)
- total cholesterol
- low HDL-c
- BP (over 140 or on meds)
- DM
- current smoking status
What groups benefit from a high intensity statins?
- Clinical ASCVD (ACS, MI, angina, stroke, TIA, revascularization, PAD)
- LDL-C 190 and over
- 40-75 y/o w/ DM and LD 70-189
- No ASCVD, LDL-C 70-189, 10 yr risk of ASCVD over 7.5%
High intensity statins lower LDL-C __-%
Moderate intensity statins lower LDL-C __-%
high: 50% or greater
moderate: 30-50%
A 35-year-old woman appears to have familial combined
hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following drugs is most likely to increase this patient’s triglyceride and VLDL cholesterolconcentrations if used as monotherapy?
A. Atorvastatin B. Cholestyramine C. Ezetimibe D. Gemfibrozil E. Colesevelam F. Niacin
B. Cholestyramine
E. Colesevelam
which of the following drugs should be avoided because of a risk of causing harm to the fetus? A. Cholestyramine B. Atorvastatin C. Niacin D. Fenofibrate E. Ezetimibe F. Rosuvastatin
B. Atorvastatin
F. Rosuvastatin
Which of the following is a major mechanism of gemfibrozil’s action?
A. Increased secretion of bile acid salts
B. Increased expression of high-affinity LDL receptors on
hepatocytes
C. Increased secretion of VLDL by the liver
D. Increased triglyceride hydrolysis by lipoprotein lipase
E. Reduced uptake of dietary cholesterol
D. Increased triglyceride hydrolysis by lipoprotein lipase
Select the major toxicity associated with gemfibrozil therapy: A. Bloating and constipation B. Cholelithiasis C. Hyperuricemia D. Liver damage E. Severe cardiac arrhythmia
B. Cholelithiasis
What are the doses of high intensity statins?
- Atoravastatin 80mg daily
2. Rosuvastain 20-40mg daily
What are the doses of moderate intensity statins?
- Atorvastatin 10-20 mg daily
- Pravastatin 40-80 mg daily
- Fluvastatin 80 mg (XL) daily
- Rosuvastatin 5-10 mg daily
- Lovastatin 40 mg daily
- Simvastatin 20-40 mg daily
- Pitavastatin 2-4 mg daily
Describe the purpose/use of chylomicrons
- Formed in intestine and carry TG/C of dietary origin
- Hydrolyzed by lipoprotein lipase (LPL) in vascular endothelium–> TG for utilization by adjacent tissues
- Chylomicron remnants then transfer C and residual TGs to liver
What is the largest lipoprotein?
Chylomicrons
85-95% TG, 3-6% C
Describe the composition of
- Chylomicrons
- VLDL
- LDL
- HDL
- Chylomicrons: 85-95% TG, 3-6% C
- VLDL: 50-60% TG, 20-30% C
- LDL: less than 10% TG, 50-60% C
- HDL: 5% TG, 25% C
Describe the physiology of VLDLs
- Secreted by liver, carriers of triglycerides / cholesterol synthesized in liver to peripheral tissues
- Hydrolyzed by LPL (FFA enter muscle-adipose tissue) –> converted to IDL –> endocytosed by liver (receptor-mediated) or converted to LDL in the plasma