Hyperlipidemia

Question 1

Which cholesterol level is most important for development of atherosclerosis

Answer 1

LDL-C

Question 2

What’s screening recommendation for HLD?

Answer 2

At risk: Men/women >20yo
genera: Men >35yo, Women >45yo

Question 3

What’s dangerous level of total cholesterol, LDL-C, HDL-C, and trig?

Answer 3

Total: >240
LDL-C: >160
HDL-C: <40
Triglyceride: >200

Question 4

What’s HLD goal for ACD/PAD/stroke?

Answer 4

Max statin to reduce LDL >50% or to <70

Question 5

What constitutes very high risk for ASCVD?

Answer 5

> 1 major event (MI/stroke/ACS/symptomatic PAD) or 1 event + high risk condition (>65, heterozygous FH, Hx of CABG/PCI, DM, HTN< CKD, smoker, CHF , LDL>100)

Question 6

What’s tx for very high risk for ASCVD?

Answer 6

Add Ezetimibe to statin to achieve LDL<70, followed by PCSK-9 inhibitor

Question 7

What’s general statin therapy?

Answer 7

If > 75, discuss risks
LDL-C>190: high intensity statin
40-75yo:
- w DM: Moderate-high statin w reduction goal >50%
- wo DM:
- LCL>70, 10y risk >7.5: statin w reduction goal >30%
- LCL70-190 w 10y risk 7.5-19.9%: Check coronary artery calcium score. Start statin if >0
- LDL 70-190 w 10y risk 5-7.4%: Lifestyle modification

Reassess 4-12 weeks after starting therapy

Question 8

How do you interpret coronary artery calcium score

Answer 8

0 : no plaque: <5% risk of CAD
1-100: minimal: <10% risk
101-400: Moderate plaque: CAD highly likely
>400: Definite extensive plaque

Question 9

What are statin intensity and doses?

Answer 9

High (LDL reduction >50%)
- Atorva 40-80mg
- Rosuva 20-40 mg (more effective)
Moderate (LDL 30-49%)
- Atorva 10-20mg
- Rosuva 5-10
- Simva: 20-40
- Prava 40-80
Mild (LDL <30%)
- Simva 10
- Prava 10-20

Question 10

What medication to use for hypertriglyceridemia?

Answer 10

> 800-100: Fibrates (gemfibrozil, fenofibrate)

Question 11

How much does smoking increase odds of PAD?

Answer 11

2-4 fold

Question 12

What’s first line therapy for smoking cessation?

Answer 12

Chantix (Varenicline) with or without nicotine patch

Question 13

How do you dose nicotine gum/lozenge?

Answer 13

2 mg if they smoke >30 minutes after waking. 4 mg if smoke <30 minutes after waking
Typically taper over 12 weeks

Question 14

How do you dose nicotine patch?

Answer 14

Full strength daily for several weeks (15-22 mg nicotine), then decrease every few weeks

Question 15

How do you dose nicotine nasal spray?

Answer 15

1 dose = 2 sprays per nostril
1-2 dose/hour, dont exceed 40 doses/day`

Question 16

How do you dose bupropion for smoking cessation? What’s contraindication?

Answer 16

150 mg qd for 3 days then 150 mg BID until end of treatment.
Seizure disorder.

Question 17

How do you dose Chantix/Varenicline?

Answer 17

Days 1-3: 0.5 mg daily
Days 4-7: 0.5 mg BID
Days 8 through end of tx: 1 mg BID
Initial duration 12 weeks. If they have quit extending another 12 weeks can reduce relapse.

CKD4: max dose is 0.5 mg BID
ESRD: max dose is 0.5 mg qd

Question 18

What’s smoking cessation abstinence rate?

Answer 18

Weeks 9-12:
Placebo: 12-18%
Bupropion: 30%
Varenicline: 40-51%
Combined: 41-55%

Weeksn 9-52 after therapy:
Placebo: 4-10%
Bupropion: 14-16%
Varenicline: 19-23%