Hyperlipidemia

Question 1

What are Major Risk Factors of Hyperlipidemia?

Answer 1

• Cigarette smoking
• HTN
• Diabetes
• Advanced age
• Lipid panel abnormalities
• CKD
• Family ASCVD history

Question 2

What are some lifestyle modifications that can reduce the risk for hyperlipidemia?

Answer 2

• healthy diet
• regular/moderate intensity exercise
• smoking cessation
• healthy weight maintenance

Question 3

True or False

Exercise should be 3-4 sessions a week. About 40 minutes per session

Answer 3

True

Question 4

The DASH diet includes:

Answer 4

• Vegetables, fruits, whole grains, low fat dairy products, poultry, fish, legumes
• Limit intake of sweets, sugary beverages, red meats, saturated fat and trans fat

Question 5

True or False

Atorvastatin and Rosuvastatin are low intensity statins.

Answer 5

False. They are High-Moderate intensity.
High Intensity: Atorvastatin 40-80 mg and Rosuvastatin 20-40 mg.
Moderate Intensity: Atorvastatin 10-20 mg and Rosuvastatin 5-10 mg.

Question 6

What percentage of lipid lowering do High, Moderate, and Low intensity statins have?

Answer 6

High Intensity: ≥50%
Moderate Intensity: 30-49%
Low Intensity: <30%

Question 7

True or False

Atorvastatin, Lovastatin, and Simvastatin are metabolized by CYP3A4.

Answer 7

True

Question 8

True or False

Atorvastatin, Pitavastatin, and Rosuvastatin have short half-lives.

Answer 8

False.
Atorvastatin: 20-30 hrs
Pitavastatin: 8-12 hrs
Rosuvastatin: 19 hrs

Question 9

Which two statins are not lipophilic?

Answer 9

Pravastatin and Rosuvastatin

Question 10

What is Myalgia?

Answer 10

• General muscle pain, involving large, proximal muscle groups symmetrically
• usually occurs within 4-6 weeks after initiation

Question 11

How should Myalgia be treated?

Answer 11

Hold statin for 2-4 weeks.

• Pain resolves: re-challenge with same statin at same or lower dose
• Pain re-emerges: discontinue original statin. Use a low dose of different statin once muscle symptoms resolve. Hydrophilic statins preferred.

Question 12

What monitoring needs to be done during statin therapy?

Answer 12

• Fasting Lipid Panel: 4-12 weeks after initiation/therapy change (3-12 months)
• Transaminases (ALT, AST)
• New onset diabetes

Question 13

How to approach Statin intolerance?

Answer 13

Try

• lower dose (less than ideal)
• different statin
• alternative doing strategy

Question 14

Describe Statin Intolerance.

Answer 14

Patient is experiencing muscle-related symptoms that:

• resolve upon Statin discontinuation
• occurs with statin re-challenge
• occurs with at least 2-3 statins (statins with different metabolic pathways, different lipophilicity and at least 1 statin prescribed at lowest approved dose)

Question 15

What are the high intensity statins?

Answer 15

Atorvastatin 40-80

Rosuvastatin 20-40