Hyperlipidemia Flashcards
what is hyperlipidemia
-Elevation of lipids (fatty substances) in the bloodstream
-Can include:
-cholesterol
-cholesterol esters
-phospholipids
-triglycerides
hyperlipidemia: primary vs secondary
-primary- familial disorder
-secondary:
-ds risk factor- DM, hypothyroid, alcohol, cushing, kidney failure
-dietary risk factor
-drug induced- hormones, steroids, diuretics, beta blockers
-MC in men than women**
cholesterol
-produced by liver- endogenous
-we consume from meat and dairy- exogenous
lipoproteins
-chylomicrons- triglycerides, cholesterol, protein -> LARGEST
-very low density lipoproteins (VLDL)
-intermediate density lipoproteins (IDL)
-low density lipoproteins (LDL)
-high density lipoproteins (HDL)- good
atherosclerosisb
-slow, progressive disease
-deposition of fatty substances (mainly cholesterol), fibrous tissue and calcium on the intimal lining of blood vessels (mainly arteries)
-aim is to lower total cholesterol and LDL or raising HDL to slow the progression of the disease and possibly reverse it.
-Atherosclerosis increases risk of CAD
-Treat with diet, drugs and exercise
lipoprotein levels
-12 hours fast
-focus on numbers that we like -> desirable
triglyceride levels
-<150 - normal
-150-199 - borderline high
-200-499 - high
-=> 500 - very high
therapeutic lifestyle changes
-Dietary Modifications
-Weight reduction
-Exercise
-Quit smoking
-increase soluble fiber*
dietary modifications
-Attempt TLC & dietary modifications first (depending on LDL levels and risk factors)
-Diet should be:
-Low in cholesterol (< 200 mg/day)
-Low in saturated fat (calories < 7% of total fat)
-Low in calories
-Avoid trans fat
-avoid alcohol
-decrease wt
“good” fat
-Monounsaturated fatty acids (MUFA)
-Aka oleic acid
-found in olive oil, canola oil, safflower oil and sunflower oil
-Also found in walnuts, almonds, peanuts and sesame seeds and olives and avocados
-Polyunsaturated fatty acids (PUFA)
-Linoleic acid (omega-6) – found in vegetable oils (soybean, safflower, sunflower and corn)
-alpha-linoleic acid (omega-3) – found in certain fish, marine oils, flaxseed and linseed oils
CHD major risk factors
-age- men > 45; women > 55
-diabetes mellitus
-family hx of early CHD- male < 55; female < 65
-HTN
-smoking
-low HDL <40
-others:
-obesity
-sedentary lifestlye
-atherogenic diet
ASCVD risk calculator
-risk factors used in calculation:
-10 year risk
-Sex
-Age
-Race
-Total Cholesterol
-HDL
-Systolic BP
-Treated for HBP
-Diabetes
-Smoker
classes of drugs
-HMG-CoA Reductase inhibitors
-Bile sequestering agents
-Fibric acid derivatives
-Nicotinic acid
-Miscellaneous
HMG-CoA reductase inhibitors
-(HMG CoA = 3-hydroxy-3-methylglutaryl-CoA)
-Aka “statin drugs”
-MOA - block the rate-limiting step in cholesterol biosynthesis (conversion of HMG CoA to mevalonic acid) thereby lowering LDL and TC levels -> Also lower TGs and raise HDL
-Lipid-lowering efficacy: Reduce LDL by 20-60%, TG by 15-60% and raise HDL 3-15% -> robust
-Efficacy increases with higher doses and more potent statins- start high
-lowers cholesterol at first step
Therapeutic Benefit:
-Plaque stabilization
-Improvement of coronary endothelial dysfunction
-Inhibition of platelet thrombus formation
-Anti-inflammatory activity- less chance of plaque attaching and building
-Evidence-based data in following patient populations
-Patients with CHD with or without hyperlipidemia
-Men w/ hyperlipidemia but no known CHD
-Men and women with average total and LDL cholesterol levels and no known CHD
-Per guidelines: First line to reduce LDL
statins ADR and pregnancy
-Contraindicated in ACTIVE hepatic disease and pregnancy
-Hepatic disease – Safe to use in non-alcoholic fatty liver disease and probably safe in Hepatitis C
-Precautions: Dose adjustments if DDIs
-GI (n,v,d)
- high LFTs, hepatotoxicity
-myopathy - myalgia, rhabdomyolosis (rare)
-CNS: ↓ cognitive function, memory loss -> Reversible upon d/c of drug, tinnitus
-CNS symptoms can just be from old age so maybe test hearing before starting
-New data on small incidence of hyperglycemia and increase HbA1C, but benefit»_space; risk in DM
Pregnancy Category X, also contraindicated in Breast Feeding
-Fetal Abnormalities include:
-Spontaneous abortion
-Congenital anomalies:
-Polydactyly
-Cleft lip
-Trisomy 18
-Club foot
-A-V septal defects
-Fetal skeletal malformations