Hyperlipidemia Flashcards
syndrome in which measured serum lipid components deviate from optimal levels
hyperlipidemia
genetic mutation in the gene encoding the LDL receptor protein that causes elevated plasma cholesterol and premature CAD
familial hypercholesterolemia
familial hypercholesterolemia should be suspected in patients with _____ _____
tendon xanthomas
characterized as elevated triglycerides, LDL and early CAD
familial combined hyperlipidemia
mutation in apo B-100 that inhibits its binding to the LDL receptor that causes elevations in LDL
familial defective apolipoprotein B-100
what might present with severe hypercholesterolemia, tendon xanthomas, and premature atherosclerosis?
familial defective apolipoprotein B-100
what is increased levels of Lipoprotein A - Lp(a) - a risk factor for? (2)
CAD
stroke
what does a patient have if they present with elevations in cholesterol, triglycerides, and are likely to develop premature CAD?
remnant removal disease
what are the top 2 secondary causes of hyperlipidemia?
obesity
uncontrolled diabetes mellitus
measures the amount of hemoglobin that is attached to glucose
A1c
how is A1c damaged by high glucose?
high glucose damages hemoglobin
at what ages should men and women with low cardiovascular risk be screened?
males over 35
females over 45
at what ages should men and women with high cardiovascular risk be screened?
males 25-30
females 30-35
what 2 measurements should a hyperlipidemia screening include?
total cholesterol
HDL
which ratio is the better predictor of CHD risk than LDL cholesterol?
non-HDL cholesterol (total cholesterol) to HDL cholesterol
measurement of calcified atherosclerosis with a non-contrast CT scan of the heart
coronary artery calcium scoring (CAC)
because statins may cause muscle pain, what should we worry about?
rhabdomyolysis
what medication can a patient, use who does not meet cholesterol treatment goals with dietary modification and maximally-tolerated statin therapy?
Ezetimibe
what medication is recommended in combination with maximally tolerated statin therapy?
Bempedoic acid
fully humanized monoclonal antibodies that bind free plasma PCSK9 that lowers LDL-C levels (PCSK9 inhibitor)
Evolocumab
Alirocumab
what is the first step in treating hyperlipidemia?
lifestyle changes
what does ASCVD include?
coronary heart disease
stroke
peripheral arterial disease
by how much should LDL-C levels be lowered in group 1 patients with ASCVD?
at least 50%
how much should LDL-C levels be in group 1 patients with multiple ASCVD events or 1 ASCVD event and high-risk conditions?
below 70
what should we do if a patient cannot hit an LDL of 70 with statins?
add ezetimibe
what should we do if a patient cannot hit an LDL of 70 with statins and ezetimibe?
add a PCSK9 inhibitor (evolocumab)
what should we do in a group 2 patient with severe primary hypercholesterolemia?
start statin therapy
what is the target in a group 2 patient with severe primary hypercholesterolemia?
100
in a group 2 patient with severe primary hypercholesterolemia, what should we do if LDL remains over 100 on a statin therapy?
add ezetimibe
in a group 2 patient with severe primary hypercholesterolemia, what should we do if LDL remains over 100 on a statin therapy and ezetimibe?
add PCSK9 inhibitor
in patients 40-75 years of age with diabetes and an LDL of 70-189, what should we do?
high-intensity statin
in patients 40-75 years of age with diabetes and an LDL of 70-189, what is the target?
decrease LDL by at least 50%
in patients 40-75 years with LCL 70-189 and an estimated 10 year ASCVD risk over 7.5%, what should we do?
start a moderate-intensity statin
in patients 40-75 years with LCL 70-189 and an estimated 10 year ASCVD risk 7.5-19.9%, what is the target?
decrease LDL by at least 30%
in patients 40-75 years with LCL 70-189 and an estimated 10 year ASCVD risk over 20%, what is the target?
decrease LDL by at least 50%
in patients 40-75 with LDC 70-189 and an estimated 10 year ASCVD risk of over 7.5% and who do not want to start statins, what should we consider?
coronary artery calcium study
what CAC score is wanted?
zero
what scores favor statin therapy, especially in those over 55 years of age?
1-99
what scores is statin therapy indicated, unless there are extenuating circumstances?
100 or above
when should lipid measurements take place after statin initiation or dose adjustment?
4-12 weeks (1-3 months)
how often should lipid measurements be repeated when managing hyperlipidemia?
every 3-12 months as needed
what are 4 side effects that patients may experience when taking a statin?
- pain/tenderness
- stiffness
- cramping
- weakness/fatigue
what should I do if a patient on a statin presents with unexplained severe muscle symptoms and fatigue? (2)
- DC statin
- work up for rhabdomyolysis
what does a work up for rhabdomyolysis include? (3)
CK
creatinine
UA for myoglobinuria
what does myoglobinuria look like?
coca cola urine
what should I do for a patient that presents with mild to moderate muscle symptoms on a statin?
- take a vacation from statin
- restart statin if symptoms resolve and no contraindications exist (same or lower dose)
what should I do for a patient that presents with mild to moderate muscle symptoms on a statin and a relationship between the two exists? (3)
- DC statin
- let symptoms resolve
- start different statin on low dose with gradual increase
what should I do for a patient over 75 years who does not have a history of heart attacks or ASCVD, but experiences muscle symptoms?
remove statin
what should I do for a patient who presents with mild to moderate muscle symptoms that continue after 2 months of no statin treatment and CK levels do not resolve?
search for secondary cause
elevated TG associated with cardiovascular disease
hypertriglyceridemia
what level of triglycerides is a risk factor for pancreatitis?
near or above 100
how do most levels of triglycerides improve?
lifestyle changes
what do very high levels of triglycerides require?
drug therapy
what can lower TG levels as much as 50%?
fish oil
what is the bad news about high cholesterol and metabolic syndrome?
asymptomatic
