Exam 1: Hyperlipidemia Flashcards
What do chylomicrons do?
Carry dietary lipids from intestine to the liver, skeletal muscle, and adipose tissue
What do VLDLs do?
Carry newly synthesized triglycerides from the liver to the adipose tissue
What do IDLs do?
Intermediate between VLDL and LDL, not usually detectable in blood
What do LDLs do?
Carry cholesterol from the liver to body’s cells
What does HDL do?
Collects cholesterol from body’s tissues and returns it to the liver.
What are the 3 pathways of lipid metabolism?
-exogenous, endogenous, and reverse cholesterol transport
What are the two types of familial hypercholesterolemia and what does it mean for their LDL levels?
1) Heterozygotes: 2x normal value of LDL
2) Homozygotes: 8x normal value of LDL
What type of inherited increased lipid disorder is present in 33-50% of patients with CHD?
Familial combined hyperlipidemia
What is secondary hyperlipidemia?
HLD with non-lipid etiology (DM, alcohol, smoking, obesity, hypothyroid, liver disease, etc)
-Less common than inherited
What is the desirable level for cholesterol?
Borderline?
High risk?
<200mg/dL
200-239
240
What is the desirable level for triglycerides?
Borderline?
High risk?
<150mg/dL
150-199
200-499
What is the desirable level for HDL?
Borderline?
High risk?
60
35-45
<35
What is the desirable level for LDL?
Borderline?
High risk?
60-130
130-159
160-189
What are plane xanthomas?
Cholesterol filled, soft yellow, plaques that appear in various places
-May indicates familial or secondary causes
What are tuberous xanthomas?
Yellow-orange nodules often located over knees and elbows, but can also be seen over tendons.
-Associated with familial hypercholesterolemia
What are eruptive xanthomas?
- Crops of small red-yellow papules with abrupt onset on the extensor surfaces and buttocks most commonly.
- Caused by elevated triglycerides over over 1500
- may indicate familial HLD
What is corneal Arcus?
-White or grey ring around the cornea, common in patients over 40yo without elevated lipids
What is the use of statins?
They decrease the incidence of major vascular events and coronary mortality and are believed to stabilize the vulnerable plaques and reduce the underlying inflammation -it is the only class of drug to demonstrate clear improvements inn overall mortality in primary and secondary prevention
What is the MOA of statins?
They inhibit HMG-CoA reductase, part of the rate limiting step in the cholesterol synthesis in the liver. Less cholesterol is produced, so the liver enzymes increase production of LDL receptors. LDL and VLDL enter liver and are digested
What are the absolute contraindications of statins and when should statins be used with caution?
Absolute contraindications: active liver disease, pregnancy
Use with caution: concomitant use with CYP3A4 inhibitors and various drugs, chronic kidney and liver disease
How should you monitor statin therapy?
- a baseline lipid panel, LFTs, and creatine kinase should be obtained
- Assess adherence and % response to meds and lifestyle changes and repeat lipid panel every 4-12 weeks after initiation or dose adjustment
- repeat every 3-12 months PRN
If a person is at high risk for ASCVD and receiving maximum tolerated statin with an insufficient response, what should you do?
Consider a non-statin LDL lowering agent
What do bile acid sequestrants do?
Binds bile acids in the intestine and decreases LDL by up to 24%.
Acts synergistically with statins and safe during pregnancy
What are the absolute and relative contraindications of bile acid sequestrants?
Absolute: TGs >400
Relative:TGs >200
What does nicotinic acid do?
- reduces production of LDL
- Increases HDL
- May reduce TGs
What are the absolute and relative contraindications of nicotinic acid?
Absolute: active liver disease
Relative: Hyperuricemia, Hyperglycemia, unstable angina
-Not used during pregnancy
What are the adverse affects of nicotinic acid?
Flushing, itching, liver damage, and safety concerns when used with statins
What do fibric acid derivatives do?
- lowers TGs up to 50%
- raises HDL up to 25%
- Primarily useful in those with high TGs
- generally not used in pregnancy
What are the absolute and relative contraindications of fabric acid derivatives?
Absolute: Severe hepatic or renal disease, preexisting gallstones, or taking simvastatin
Relative: other statin use, concurrent warfarin use
What does ezetimibe do?
- Used on conjunction with a statin, it blocked intestinal absorption of dietary and biliary cholesterol via a transporter.
- Can lower LDL up to 17%
What are the contraindications of ezetimibe?
-Use with a statin in liver disease, pregnancy
What do PCSK9 inhibitors do?
The inhibit a protease that causes increased LDL from being produced in the liver. This process can reduce LDL as much as 70% and reduce cardiovascular events and mortality
What is the difference between primary and secondary prevention?
Secondary prevention in statin therapy in patients that already have ASCVD. in primary prevention, patients do not have ASCVD
What are the 3 categories of primary prevention?
1) individuals with LDL > 190
2) individuals with DM aged 40-75 with LDL > 70
3) individuals w/o ASCVD or DM with LDL 70-189 and estimated 10 year ASCVD risk >7.5%
