Dyslipidemias - Clinical Features and Management Flashcards
Lipid hypothesis:
-elevated serum cholesterom levels directly linked to atherosclerosis
Major modifiable risk factors for atherosclerosis:
- smoking
- diabetes mellitus
- HTN
intensity of ASCVD-preventative therapy is based on:
-serum lipid levels AND risk factors!
Non drug treatment:
- diet mod
- regular exercise
- attain and maintain optimum weight
- not smoking
High Total cholesterol level
260<
Hgih LDL-C level?
160<
Which diet works well for high LDL-C diet?
DASH DIET (dietary approach to stop hypertension)
What is the target level for LDL-C treatment?
there is no level anymore - we match the intensity of preventative treatment to absolute individual risk of ASCVD over 10 year period
Drug of choice for cholesterol dyslipidemias?
-STATINS - HMG-CoA reductase inhibitors
Benefit to using statis?
- reduce LDL and TG
- increase HDL
==> reduce major coronary events ==>reduce CAD mortality ==>reduce coronary procedures ==> reduce stroke ==> reduce total mortality
Major side effects to statins:
- myopathy
- inc liver enzymes
Contraindication to statins?
-liver disease!
4 major statin benefit groups:
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
What to give patients with ASCVD (CHD, nonfatal MI< stroke..etc) and=7.5%?
HIGH INTENSITY STATIN
Do not use statin therapy for people with:
heart failure class 2-4 and people on maintenance hemodialysis
If 21yr or older patient with just LDL>=190 but no clinical ASCVD - what to do?
just need to start on hgih intensity statin
If 21yo without diabetes and LDL-C 70-189 with estimated 10yr risk of 7.5% of greater-what to do?
-mod or high intensity statin
Less than 75 with no safety concerns but has clinical ASCVD - what to do?
high intensity statin (secondary prevention)
Older than 75 with safety concerns and clinical ASCVD - what to do?
moderate intensity statin (secondary prevention)
LDL-C>=190 but no clinical ASCVD - what to do?
(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
high intensity statins:
Atorvastatin
rosuvastatin
Moderate intensity statins:
atorvastatin rosuvastatin simvastatin pravastatin lovastatin
Low intensity statins:
pravastatin
lovastatin
Bile acid sequestrants
- major actions
- side effects
1) reduce LDL 15-30%
- raise HDL 3-5%
- may inc TG
2) -GI issues
- dec absorption of other drugs
Bile acid sequestrants
-contrainications:
- hgih TGs
- dysbetalipoproteinemia
Bile acid sequestrant drugs:
- cholestyramine
- cholestipol
- colesevelam
Bile acid sequestrants - benefits:
- reduce major coronary events
- reduce CAD mortality
nicotinic acid
- major actions
- side effects:
1) lowers LDL 5-25%
-lowers TG20-50%
-raises HDL 15-35%
2) flushing
hyperglycemia
hyperuricemia
upper GI distress
liver tox
(NIACIN) nicotinic acid -contraindications:
- liver disease
- severe gout
- peptic ulcer
nicotinic acid - benefits:
- reduces major coronary events
- possible reduction in total mortality
fibric acid derivatives:
- used for?
- actions?
- 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%
Fibric acids
- side effects:
- contraindications:
1) dyspepsia
gallstones
myopathy
2) Severe renal or hepatic disease
fibric acids therapeutic bebefits:
- reduce progression of coronary lesions
- reduce major coronary events
