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N810 > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

CVD: Risk factors

A
  • HTN
  • DM
  • Obesity
  • Dyslipidemia
  • Smoking
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2
Q

Trends: Ethnic Variations in Lipids

A
  • Total lipids down: Except in Mexican-Americans
  • HDL up: Except in non-hispanic black and mexican-americans
  • LDL down
    TG down
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3
Q

ATP-III Guidelines

A
  • CHD Risk Equivalents: CAD, DM, AAA, carotid artery stenosis >50%, CVA or TIA, PAD, Framingham score >20%
  • Risk Factors: Age (M>45, W>55), Family Hx CV event (M<40, HTN, smoking
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4
Q

ATP-III: LDL Goals

A
  • CHD or risk equivalent: <160
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5
Q

ATP-III: Treatment Guidelines

A
  • CHD or risk equivalent: >=130

- 2+ Risk factors: (10-20%) =190

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6
Q

ATP-III: Very high risk

A
  • LDL goal <70 with established CHD and:
  • Multiple risk factors
  • Poorly controlled risk factors (smoking, DM)
  • Metabolic syndrome
  • ACS
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7
Q

High LDL: Pharmacotherapy

A
  • HmgCoa Reductase Inhibitors: Statins (DOC)
  • Bile Acid sequestrants: cholestyramine, colestipol
  • Cholesterol Absorptions inhibitors: ezetimibe
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8
Q

Statin Equivalency

A
  • Lovastatin: 40
  • Pravastatin: 40
  • Simvastatin: 20
  • Atorvastitin: 10
  • Fluvastatin: 80
  • Rosuvastatin: 5
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9
Q

Statin-Induced Myalgias and Intolerance: Facts

A
  • Hepatic statin transporter polymorphism that is associated with myopathy
  • Severe myopathies are rare; myalgias are more common
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10
Q

Statin-Induced Myalgias and Intolerance: Risk factors

A
  • Age >70
  • polypharmacy
  • female gender
  • high-dose statin
  • Low BMI
  • Liver or kidney disease
  • substance abuse
  • Untreated hypothyroidism
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11
Q

Statin-Induced Myalgias and Intolerance: Prevention and treatment

A
  • Use lowest effective dose
  • Identify risk factors before initiation
  • Obtain CK in any patient with myalgia on statin
  • Myalgias resolve within 2mo
  • Patients can be tried on another statin at a lower dose
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12
Q

What do you do with truly statin intolerant patients?

A
  • Ezetimibe, BAS, Fibrate, Niacin

- Lifestyle modification

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13
Q

Low HDL (M <50): Causes

A
  • Common in DM and CAD

- Extremely low (<20): may be r/t steroids, TZDs, malignancy, fibrates, disorders of ApoA-I

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14
Q

Low HDL: Facts

A
  • Risk factor for CHD

- May be some benefit in lowering both HDL and LDL (Conflicting evidence)

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15
Q

Raising HDL

A
  • Drugs: Statins and ezetimibe (slight increase), Fibrates, Niacin
  • Lifestyle: smoking cessation, obesity, lack of physical activity, Mediterranean diet, Moderate ETOH consumption
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16
Q

Triglycerides: Pathophysiology

A
  • Formed into chylomicrons in gut
  • Some are synthesized in free fatty acids, remainder contain lipids
  • Lipids particles are synthesized into VLDL
  • VLDL in internal transit system for lipids
  • TG levels include chylomicrons and concentration of TG in VLDL
  • VLDL with high TG concentrations are not cleared efficiently and more readily converted to LDL
17
Q

Hypertriglyceridemia: Causes

A
  • Primary: Familial disorders, DM, Metabolic syndrome

- Secondary: ETOH, Poorly controlled DM, CKD, liver Dz, pregnancy, autoimmune disorders, certain drugs

18
Q

Drugs that cause high TG

A
  • TZ diuretics
  • B-blockers
  • Estrogens
  • Isotretinoin
  • Corticosteroids
  • Bile-acid sequestrants
  • Protease inhibitors
  • Immunosuppressants
  • Anti-psychotics
19
Q

Endocrine Society Guidelines: TG

A
  • Screen q 5yr in adults
  • Use fasting to make diagnosis
  • If high Tg found, look for secondary causes and other CV risks
20
Q

High TG Risks

A
  • Mild-to-moderate elevations are probably CV risk factors
  • 2000): known to cause pancreatitis
  • Severe (1000-1999)
21
Q

Hypertriglyceridemia: Management (general)

A
  • Decrease sugar and simple carbs (Fructose worse than sucrose or glucose); Exercise, Weight loss
  • Meds: Fibrates, Niacin, n-3 fatty acids, Statins (esp. if CV risk)
22
Q

Hypertriglyceridemia: Management (Specific)

A
  • Mild (150-199): Lifestyle
  • Moderate (200-999): Fibrate OR Niacin OR n-3 fatty acids with or w/out a statin
  • Severe (1000-1999): Drug + Lifestyle, do NOT use statin as monotherapy
23
Q

Ezetimibe (Zetia)

A
  • Decreases absorption of cholesterol in gut
  • Effectively lowers LDL; not shown to benefit cardiac events
  • May reduce atherosclerosis in those with CKD
24
Q

Other Investigational Drugs: Lipids

A
  • Monoclonal antibody therapy to improve LDL clearance: increases degradation of LDL receptors on hepatocytes to lower LDL concentration
  • Cholesterol ester transfer protein inhibitor (Anacetrapid): Raises HDL, Lowers LDL
25
Q

Lipid-Markers

A
  • Total cholesterol, HDL, LDL
  • Apolipoproteins A-1 and B, lipoprotein (a), lipoprotein-associated psopholipase A2
  • CRP: elevated levels along with high LDL has been shown to increase risk of CHD

N810 (18 decks)

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