Dyslipidemia lecture Flashcards
The ASCVD-risk assessment evaluates a _______-year atherosclerotic cardiovascular disease incident
10
List / describe 2 subtypes of dyslipidemias
1) Hypertriglyceridemia can lead to pancreatitis or eruptive xanthomas when very high TG levels (>500 mg/dL)
2) Low HDL-C
(also Diabetic dyslipidemia)
According to AHA estimates, approximately 45% of American adults aged 20 or older have total cholesterol levels exceeding _________mg/dL
200
Estimates from the National Cholesterol Education Program (NCEP) state that only ______% of patients have an optimal LDL-C (<100 mg/dL)
26%
The underlying causes of dyslipidemias can be categorized into two types; what are these types?
primary or secondary
List 3 etiologies of dyslipidemias
1) Familial
2) Primary
3) Secondary
Primary Dyslipidemias: What are 2 types?
1) Homozygous familial hypercholesterolemia (HoFH) (rare)
2) Heterozygous familial hypercholesterolemia (HeFH)
(less rare; 1 case per 250 people)
List drugs that can induce secondary or acquired dyslipidemias
1) Atypical antipsychotics & ritonavir
2) Diuretics, beta blockers, glucocorticoids, oral estrogen and progestin, tacrolimus, and cyclosporin can be associated with weight gain or hyperglycemia and cause dyslipidemias
In the liver:
1) __________ is converted to pyruvate and then to acetyl-CoA
-Acetyl-CoA is eventually converted to HMG-CoA reductase
2) What is the target for statins?
1) Glucose
2) HMG-CoA reductase
Only empty HDL and VLDL are made in the liver:
1) VLDL is transported across lipase, which changes the VLDL to IDL (aka _________________________)
2) IDL can then be converted to __________.
1) intermediate-density lipoproteins
2) LDL
Familial hypercholesteremia:
Primary defect in familial hypercholesterolemia is the inability to bind ____________ to the _________ receptor (so stuck in bloodstream)
LDL to the LDL
Many patients with dyslipidemia present with one or more of the following abnormalities; list them
Abdominal obesity
Atherogenic dyslipidemia
Increased blood pressure
Insulin resistance and/or glucose intolerance
Prothrombotic or proinflammatory state
Patients with _________ or more of the abnormalities of dyslipidemia are considered to have metabolic syndrome
three
1) Who should you recommend a heart-healthy lifestyle to?
2) What should you recommend for those very high risk for ASCVD?
3) What should you do for those age 75+ who aren’t very high risk?
1) Everyone
2) High intensity or max tolerated statin therapy
3) Moderate or high intensity statin therapy
1) Define severe hypercholesterolemia
2) What diabetics should you initiate primary prevention for? What is this prevention?
1) LDL >/= 190 mg/ dL
2) Ages 40-75 and LDL of 70-189mg/dL (1.81-4.8 mmol/L):
Moderate-intensity statin therapy regardless of 10 yr ASCVD risk
Nondiabetics
1) What nondiabetics should you initiate primary prevention for?
2) Based on 10 yr risk, what should you do for those high risk (>/=20%)?
3) What abt those with intermediate risk? (>/= 7.5% to <20%)
4) What abt low risk? (<5%)
1) 40-75 yrs and LDL of 70-189 mg/ dL (1.81-4.89 mmol/L)
2) Initiate high intensity statin therapy
3) If risk enhancers present, consider moderate intensity statin therapy
4) Emphasize heart-healthy lifestyle
Describe primary prevention for those 20-39 y/o and LDL of 70-189 mg/ dL
Encourage lifestyle to reduce ASCVD risk
1) Nonstatin lipid-lowering therapies (such as ezetimibe, bempedoic acid, and PCSK9 inhibitors) play a supportive role in the management of dyslipidemia and are primarily used in combination with what?
2) When are they used as monotherapy?
1) Statins
2) In patients unable to tolerate the recommended dose of a statin
Although the _______________-style diet has no consistent effect on LDL-C levels, it has been shown to reduce major cardiovascular events among persons at high cardiovascular risk when compared to a control diet
Mediterranean
List 2 dietary supplements that reduce LDL by binding cholesterol
Soluble fiber and psyllium
Dietary supplements:
1) Describe Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
2) What is important to know abt red yeast rice?
1) Omega-3 fish oil
Reduces triglycerides and VLDL-C
Anti-inflammatory properties
2) Avoid concurrent use with prescription statins
Recommend a brand with the USP seal of approval
True or false: Phytosterols are an OTC that reduces LDL
True
Familial hypercholesterolemia: List 2 orphan drugs used for it
1) Mipomersen (Kynamro)
2) Lomitapide (Juxtapid)
Familial hypercholesterolemia
1) How is Mipomersen (Kynamro) administered?
2) How is Lomitapide (Juxtapid) given?
3) What do both of these have in common?
1) SubQ
2) PO
3) BBW for hepatotoxicity & are orphan drugs
Besides route of administration, what differentiates Mipomersen (Kynamro) from Lomitapide (Juxtapid)?
1) Mipomersen (Kynamro): Reduces LDL-C levels by ∼25%
2) Lomitapide (Juxtapid): Reduces LDL-C levels by ∼40%
Statin therapy should be generally discontinued in who?
Patients with intolerable symptoms
HMG-CoA reductase inhibitors (Statins):
____________, ____________, and sometimes __________ are associated with more significant drug–drug interactions since they are predominantly metabolized by CYP3A4
Lovastatin, simvastatin, atorvastatin
Cholesterol absorption inhibitors
1) What is the minor side effect (although it’s generally well-tolerated)?
2) Concomitant use with ___________ can lead to increased exposure to both ezetimibe and __________
1) Minor GI side effects/ diarrhea
2) cyclosporine; cyclosporine
Cholesterol absorption inhibitors:
1) _______________ comes as tablets
2) What 2 kinds come as powder?
1) Colesevelam
2) Colestipol and cholestyramine
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors:
1) Both alirocumab and evolocumab are fully human monoclonal antibodies to PCSK9 and were approved by the FDA in _________.
2) What are some adverse effects?
3) What is a downside of these?
1) 2015
2) Injection site reactions, allergic reactions, infections, and post shot “flu-like” symptoms
3) Expensive $$$
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: List 2 of them and their initial doses
1) Alirocumab (Praluent): 75 mg SUBQ every two weeks or 300 mg SUBQ every month
2) Evolocumab (Repatha): 140 mg SUBQ every two weeks or 420 mg SUBQ every month
What may amplify the flushing and itching assoc. with Niacin (Vitamin B3)? What helps?
1) Concomitant alcohol and hot beverages may magnify flushing and pruritus with niacin
2) Extended-release products associated with decreased risk compared to instant release products
Niacin modestly increases __________________ and HbA1c levels (so don’t use in people with diabetes)
fasting plasma glucose
Can you use statins in patients with kidney disease?
Yes, just reduce the dose
