Evidence & Guidelines of Dyslipidemia Flashcards
What is the primary mechanism for how statins improve hyperlipidemia?
Lower LDL
What positive effect does lowering LDL have on health? (2)
1) Helps prevent the development of CAD
2) Helps prevent first occurrence of coronary event
What is the definition of PRIMARY PREVENTION r/t dyslipidemia?
No interventions or medical event has occurred
What medical condition automatically warrants initiation of statin therapy
Diabetes
If a patient has a baseline LDL >190, what intensity of statin should be prescribed and what is the goal of that treatment?
High Intensity
Class I= 50% reduction in LDL from baseline
If a patient has DM and is age 40-75, what intensity of statin should be prescribed and what is the goal of that treatment?
Medium Intensity
Class I=30-50% reduction in LDL from baseline
*consider risk assessment to consider high-intensity statin therapy
What are the ASCVD risk percentage ranges? (4)
<5% is low risk
5-<7.5% is borderline risk
>7.5-<20% is intermediate risk
>20% high risk
What is the appropriate intervention for a patient at ‘borderline risk’ of ASCVD?
Discuss risk /r/t moderate-intensity STATIN therapy, Class IIB)
*5-<7.5%
What is the appropriate intervention of a patient at intermediate or high risk of ASCVD?
STATIN Therapy, Class I
*>7.5-<20% is intermediate risk
>20% high risk
What is the appropriate intervention for a patient with familial hypercholesterolemia (HeFH)?
Statin therapy, regardless of age to prevent early age MIs (in 20s)
When should STATIN therapy be initiated? (14)
If over 7.5% risk AND, at least one of the following: Over 65 years HeFH Hx of CABG or PCI apart from ASCVD DM CKD w/eGFR 15-59 ML/min Smoker LDL>100 despite max tolerated statin and ezetimibe Hx of CHF Hx of preeclampsia Hx of premature menpause Chronic inflammatory disease (RA, HIV) South Asian Ancestry Persistent TG >175 (related to shifting in LDL to small dense particals)
When should High-Intensity, PRIMARY PREVENTION Statin therapy be initiated?
ASCVD risk >20%
What is the LDL lowering goal of High-Intensity, PRIMARY PREVENTION Statin therapy?
50%
What are the drugs/dosages used in high-intensity, PRIMARY PREVENTION Statin therapy? (2)
Atorvastatin 10-20 mg
Rosuvastatin 20-40mg
When should Medium-Intensity, PRIMARY PREVENTION Statin therapy be initiated?
ASCVD RISK >7.5-<20%
What is the LDL lowering goal of Medium-Intensity PRIMARY PREVENTION Statin therapy?
30-49%
What are the drugs/dosages used in Medium intensity, PRIMARY PREVETNEION Statin therapy? (3)
Atorvastatin 10-20 mg
Rosuvastatin 5-10mg
Simvastatin 20-40mg
Which statin is contraindicated for use in those of Asian ethnicity?
What is the risk?
Rosuvastatin
Johnston Syndrome
When should low-intensity PRIMARY PREVENTION Statin Therapy be initiated?
ASCVD <5%
What is the LDL lowering goal of low-intensity PRIMARY PREVENTION Statin Therapy?
<30%
What drug/dosage is indicated for low-intensity PRIMARY PREVENTION Statin therapy?
Simvastatin 10mg
What is the definition of Secondary Prevention r/t dyslipidemia?
An event has occurred (MI, etc), and now trying to prevent others.
What conditions/events are present for defining Secondary Prevention r/t dyslipidemia? (5)
1) ASCVD, recent or multiple ACS events (STEMI/NSTEMI/unstable angina) within last 12 months
2) Hx of MI (other than recent ACS events above)
3) Hx of ischemic stroke
4) Symptomatic PD
5) Previous revascularization or amputation
What is the LDL lowering goal in Secondary Prevention of dyslipidemia?
<70%
But baseline labs not needed (need one of you to explain to me how this works) :)
In SECONDARY PREVENTION therapy for dyslipidemia, what drug can be added if the patient is already on the max dose of therapy without adequate effect?
Ezetimibe
In SECONDARY PREVENTION therapy for dyslipidemia, what drug can be added to max statin dose and Exetimibe if no adequate effect?
PCSK9-I
What are the disadvantages of PCSK9-I therapy? (3)
Very expensive
Must get pre-authorization for use
Only given parenterally
What are treatment considerations if TG is >1000? (5)
1) Treat underlying problems (DM, meds, hypothyroidism, obesity, CKD, nephrotic syndrome)
2) Low-fat diet
3) Avoid refined carbs
4) Avoid Etoh
5) Consume O3FA and +/- fibrate (to decrease the risk of pancreatitis)
What should happen in statin therapy if the patient becomes pregnant?
STOP statins immediately–cholesterol is needed to make hormones
What should happen if a patient on statin therapy is planning to get pregnant?
Stop statin 1-2 months prior to trying to become pregnant
What should statin therapy treatment plan be for someone who is not pregnant but who is sexually active?
Use RELIABLE birth control while on Statin
What are dyslipidemia treatment considerations if pt has CKD and is on hemodialysis?
If not on a statin, don’t initiate
If already on station prior, continue statin
What are dyslipidemia treatment considerations in patients with HIV or chronic inflammatory disease?
Reassess lipid and risk after the disease is under control.
A 40mg/dL decrease in LDL correlates to what percentage of decreased risk of major vascular events?
25%
When treating high LDL, is the focus on staying within specific ranges or percentage of LDL reduction?
Percentage of reduction.
What groups of people are the highest risk for developing clinically relevant ASCVD? (3)
Ldl -c> 190
Diabetics age 40-75
Those with a 10 year risk of >75% and who are 40-75 years old
What statins are HIGH INTESITY Statins? (2)
Atorvastatin (Lipitor), 40-80 mg
Rosuvastatin (Crestor), 20-40mg
What statins are MEDIUM INTENSITY Statins? (6)
Atorvastatin (Lipitor), 10-20 mg Rosuvastatin (Crestor), 5-10mg Simvastatin, 20-40mg Pravastatin, 40-80 mg Fluvastatin XL, 80mg Pitavastatin, 2-4 mg
Non-traditional risk factors for dyslipidemia (4)
Family history
Increased CRP levels
High Coronary Calcium Score
Ankle Brachial Index (peripheral arterial disease)
What are baseline monitoring recommendations for the treatment of dyslipidemia? (4)
Baseline Lipid Profile
Baseline LFTs
Baseline Hbg A1C
Baseline Thyroid Function test
What follow-up monitoring is recommended during the treatment of dyslipidemia?
Lipid profiles every 4-12 weeks after starting statins and then every 3-12 months to assess response adherence
Once statins are initiated, at what point can the dosage be reduced?
Dosages can be reduced when LDL-C < 40 on 2 consecutive occasions
