Hyperlipidemia Flashcards
Primary Hyperlipidemia
-Familial causes
-Types I-V
Fredrickson Classification
Secondary Hyperlipidemia
– Acquired
Due to other underlying cause
Modifiable risk factors
Medication use (beta blockers, thiazide diuretics, glucocorticoids, estrogen)
Risk of CVD
Lifetime risk decreases to 5% with: Recommended Physical Activity Recommended Diet No Smoking LDL < 100 mg/dL Fasting glucose < 100 mg/dL SBP < 120 mmHg
-If one factor is not optimal risk increases to 30%
Screening Recommendations
Start at age 18 (Lipids and Fasting glucose)
Screen every 5 years
(men > 35, women > 45)
Determine Framingham Score or ASCVD Risk Score
Additional screening in special circumstances
-Fast 9-12 hrs prior to draw
Cholesterol
Desirable < 200 mg/dL
Borderline 200-239 mg/dL
High > 240 mg/dL
Triglycerides
Desirable < 150 mg/dL
Borderline 150-199 mg/dL
High 200- 499 mg/dL
Very High > 500 mg/dL
HDL (Good)
Low < 40
High > 60 mg/dL
LDL (Bad)
Optimal < 100 mg/dL Near optimal 100-129 mg/dl Borderline 130-159 mg/dL High 160-189 mg/dL Very High > 190 mg/dL
Hyperlipidemia risk factors
Age (+/-) Gender (+/-) Obesity Abnormal fasting blood glucose (DM) Tobacco use Heavy Alcohol use Elevated Systolic Blood Pressure
Dyslipidemia
abnormal amounts of lipids in blood; most are hyperlipidemias
Hypercholesterolemia
elevated cholesterol (LDL); >200 mg/dL
Hypertriglyceridemia
elevated triglycerides; > 150 mg/dL
Lipid Disorders
Hyperlipidemia: elevated lipid (fat) levels or lipoproteins in the blood
-Particles classified according to density
-Measures: Cholesterol Triglycerides LDL HDL Non-HDL cholesterol
HMG-CoA Reductase Inhibitors / statins
Atorvastatin (Lipitor)
Simvastatin (Zocor) – DO NOT USE 80 mg dose-can have more drug interactions
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Lovastatin (Mevacor)**
Fluvastatin (Lescol)
2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 1
patients ≥21 years of age with clinical ASCVD
2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 2
adults ≥21 years of age with LDL-C ≥190 mg/dl (not due to secondary modifiable causes)
2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 3
adults aged 40-75 years without ASCVD, but with diabetes and with LDL-C 70-189 mg/dl
2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 4
adults aged 40-75 years without ASCVD or diabetes, with LDL-C 70-189 mg/dl, and an estimated 10-year risk for ASCVD of ≥7.5%, as determined by the Pooled Cohort Equations
Statin Therapy: High-intensity statin
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg
Statin Therapy: Moderate
Atorvastatin 10-20 mg Rosuvastatin 5-10 mg Simvastatin 20-40 mg Pravastatin 40-80 mg Lovastatin 40 mg Fluvastatin XL 80 mg Fluvastatin 40 mg bid
Additional Agents
Ezetimibe (Zetia)– preferred 1st non-statin add on
Vytorin (Simvastatin + Ezetimibe)
Nicotinic Acid (Niacin)
Ubiquinone (Coenzyme Q 10)
Alcohol (red wine)
PCSK9 Inhibitor (for additional LDL lowering if not at goal on statin therapy-use w/ statin drug
Evolocumab (Repatha) injections- 140 mg/ml injection every 2 weeks
Alirocumab (Praluent) injections- 75 mg/ml injection every 2 weeks
Very expensive
Prescribed by specialists
Hypertriglyceridemia
Gemfibrozil(Lopid)
Fenofibrate (TriCor)
Omega-3 fatty acids/ Fish Oil/ Lovaza
-Treat all w/ triglyceride level >500 mg/dl to prevent acute pancreatitis
Ongoing Monitoring
- Reassess fasting lipids in 6-8 weeks after starting treatment
- Obtain baseline LFTs before initiating statins
- Check baseline CK in risk patients
- Data does not support monitoring LFTs routinely
- Cautious use of Statins with Finofibrates (esp. Gemfibrozil)*
- Check Creatine Kinase (CK) if suspect statin- associated myopathy or rhabdomyolysis (rare)
