Dyslipidemias - Clinical Features and Management

Question 1

Lipid hypothesis:

Answer 1

-elevated serum cholesterom levels directly linked to atherosclerosis

Question 2

Major modifiable risk factors for atherosclerosis:

Answer 2

• smoking
• diabetes mellitus
• HTN

Question 3

intensity of ASCVD-preventative therapy is based on:

Answer 3

-serum lipid levels AND risk factors!

Question 4

Non drug treatment:

Answer 4

• diet mod
• regular exercise
• attain and maintain optimum weight
• not smoking

Question 5

High Total cholesterol level

Answer 5

260<

Question 6

Hgih LDL-C level?

Answer 6

160<

Question 7

Which diet works well for high LDL-C diet?

Answer 7

DASH DIET (dietary approach to stop hypertension)

Question 8

What is the target level for LDL-C treatment?

Answer 8

there is no level anymore - we match the intensity of preventative treatment to absolute individual risk of ASCVD over 10 year period

Question 9

Drug of choice for cholesterol dyslipidemias?

Answer 9

-STATINS - HMG-CoA reductase inhibitors

Question 10

Benefit to using statis?

Answer 10

• reduce LDL and TG
• increase HDL

==> reduce major coronary events
==>reduce CAD mortality
==>reduce coronary procedures
==> reduce stroke
==> reduce total mortality

Question 11

Major side effects to statins:

Answer 11

• myopathy

- inc liver enzymes

Question 12

Contraindication to statins?

Answer 12

-liver disease!

Question 13

4 major statin benefit groups:

Answer 13

1) secondary prevention - clinical ASCVD
2) Primary prevention-individuals with pimary LDL elevation >190
3) Primary prevention-diabetics 40-75yo and LDL level 70-189
4) primary prevention-without diabetes but estimated 10-year CVD risk>=7.5%, age 40-75 with LDL 70-189

Question 14

What to give patients with ASCVD (CHD, nonfatal MI< stroke..etc) and=7.5%?

Answer 14

HIGH INTENSITY STATIN

Question 15

Do not use statin therapy for people with:

Answer 15

heart failure class 2-4 and people on maintenance hemodialysis

Question 16

If 21yr or older patient with just LDL>=190 but no clinical ASCVD - what to do?

Answer 16

just need to start on hgih intensity statin

Question 17

If 21yo without diabetes and LDL-C 70-189 with estimated 10yr risk of 7.5% of greater-what to do?

Answer 17

-mod or high intensity statin

Question 18

Less than 75 with no safety concerns but has clinical ASCVD - what to do?

Answer 18

high intensity statin (secondary prevention)

Question 19

Older than 75 with safety concerns and clinical ASCVD - what to do?

Answer 19

moderate intensity statin (secondary prevention)

Question 20

LDL-C>=190 but no clinical ASCVD - what to do?

Answer 20

(primary prevention)

• look for secondary causes of dyslipidemias
• high intensity statin
• try to reduce LDL-C by more than 50%
• LDL-C non statin therapy

Question 21

high intensity statins:

Answer 21

Atorvastatin

rosuvastatin

Question 22

Moderate intensity statins:

Answer 22

atorvastatin
rosuvastatin
simvastatin
pravastatin
lovastatin

Question 23

Low intensity statins:

Answer 23

pravastatin

lovastatin

Question 24

Bile acid sequestrants

• major actions
• side effects

Answer 24

1) reduce LDL 15-30%
- raise HDL 3-5%
- may inc TG
2) -GI issues
- dec absorption of other drugs

Question 25

Bile acid sequestrants

-contrainications:

Answer 25

• hgih TGs

- dysbetalipoproteinemia

Question 26

Bile acid sequestrant drugs:

Answer 26

• cholestyramine
• cholestipol
• colesevelam

Question 27

Bile acid sequestrants - benefits:

Answer 27

• reduce major coronary events

- reduce CAD mortality

Question 28

nicotinic acid

• major actions
• side effects:

Answer 28

1) lowers LDL 5-25%
-lowers TG20-50%
-raises HDL 15-35%
2) flushing
hyperglycemia
hyperuricemia
upper GI distress
liver tox

Question 29

(NIACIN) nicotinic acid -contraindications:

Answer 29

• liver disease
• severe gout
• peptic ulcer

Question 30

nicotinic acid - benefits:

Answer 30

• reduces major coronary events

- possible reduction in total mortality

Question 31

fibric acid derivatives:

• used for?
• actions?

Answer 31

• mostly used for hyperTGs
• lower LDL 5-20% (if nml TG)
• may raise LDL (if high TG)
• lower TG 20-50%
• raise HDL 10-20%

Question 32

Fibric acids

• side effects:
• contraindications:

Answer 32

1) dyspepsia
gallstones
myopathy
2) Severe renal or hepatic disease

Question 33

fibric acids therapeutic bebefits:

Answer 33

• reduce progression of coronary lesions

- reduce major coronary events