Dyslipidemia Guidelines Flashcards
What conditions are statin indicated conditions?
Any condition for which pharmacotherapy with statins is indicated, and consists of any documented ASCVD conditions, and other high risk primary prevention conditions- Clinical atherosclerosis, abdominal aortic aneurysm, diabetes, CKD, dx of familiar hypercholesterolemia
ASCVD is a common term in the dyslipidemia guidelines. What does it mean?
Atherosclerotic cardiovascular disease. All clinical conditions for atherosclerotic origin, including ACS, MI, stable or unstable angina, CAD (documented using angiography, coronary or other arterial revascularization), stroke, TIA, documented carotid disease, peripheral arteria disease, AAA
Why do we care so much about dyslipidemia?
Important risk factor for atherosclerotic CVD
Define primary prevention vs. secondary prevention
Primary- all efforts aimed at either populations/ individuals to prevent/ delay onset of ASCVD
Secondary- Efforts to treat known, clinically significant ASCVD, and to prevent or delay the onset of disease manifestations
What age should screening for dyslipidemia start at?
M= 40 years
F= 40 years (or postmenopausal)
Consider earlier for any people with evidence of atheroscelorosis, AAA, DM, arterial HTN, smoker, manifestations of dyslipidemia (i.e. corneal arcus), fam hx premature CVD or dyslipidemia, CKD with GFR <60, Obesity (BMI> 35), inflammatory disease, HIV, ED, COPD, hx HTN of pregnancy)
Consider earlier in ethnic groups at increased risk, such as South Asian or Indigenous
What are the components of screening for dyslipidemia in adults at risk?
History and physical exam, lipid profile (TC, LDL-C, HDL-C non HDL-C, TG), FPG or A1C, eGFR, lipoprotein (once in patients lifetime, with initial screening).
Optional: ApoB, Urine ACR if eGFR< 60, HTN, or DM
What is a frequently used tool for assessing CV risk in patients in Canada?
Framingham Risk Score (FRS) (Susan seems to focus on this)
We also use the Cardiovascular Life Expectancy model (CLEM)
How often do we conduct the FRS to assess for CV risk?
Every 5 years for M/F aged 40-75 yrs
Fun fact: Among individuals 30-59 years of age without diabetes, the presence of history of premature CVD in a first degree relative (i.e., <55 for male relatives, <65 for female relatives) increases an individuals calculated FRS percent risk by about ____________ times
2 times!
Lifestyle/ health behavior interventions are always incorporated into treatment of dyslipidemia and CVD prevention. Name some of the recommendations.
Attaining and maintaining a healthy body weight
Consuming a healthy diet (mediterranean, DASH, low glycemic index, plant based, diet high in nuts/ legumes/ olive oil/ fruits, veggies, fibre, whole grains)
Regular physical activity (accumulate 150 minutes of MOD to VIGOROUS aerobic activity per week; may also be beneficial to add muscle/ bone strengthening exercises)
Smoking cessation
Limiting etoh consumption
Adequate sleep
For every 1mmol LDL-C is reduced, what is the benefit in CVD risk reduction?
This is more of a fun fact :) but for every 1mmol reduction in LDL-C, studies consistently show a 20-22% relative risk reduction in CVD risk scores!!!!
Statin therapy should be initiated for who?
1) high risk patients (greater than or equal to 20% 10 year risk)
2) intermediate risk patients (10-19.9%) when LDL-C is greater than or equal to 3.5mmol/L (or non HDL-C >4.2, or ApoB>1.05); Men >50 and F> 60 with low HDL, high waist circumference, smoker, HTN, or other risk factors)
3) Low risk subjects (FRS <10%)- focus on health behavior modification, but treat if LDL-C>5.0mmol/L, statin indicated condition. Treatment of this group would follow an intermediated risk approach.
What is the first line add on therapy for patients treated with maximally tolerated statin doses?
Ezetimibe
