Hyperlipidemia Flashcards
How is the atherosclerotic cardiovascular disease (ASCVD) risk calculated?
Using the Pooled Cohort Equations risk calculator.
When are children/young adults screened for dyslipidemia?
9 to 11 and then again 17 to 21.
For average/low risk patients, what is the interval for surveillance for dyslipidemia?
every 4 to 5 years
Males are screened for dyslipidemia starting at what age?
35 years old
Females are screened for dyslipidemia starting at what age?
45 years old
This patient has established atherosclerotic cardiovascular disease (ASCVD) based on her previous myocardial infarction. Patients with known ASCVD are at high risk for future cardiovascular events and death. Several randomized trials for secondary prevention of ASCVD have shown significant risk reduction in cardiovascular events and overall cardiovascular disease mortality in patients treated with statins.
Current guidelines recommend high-intensity statin therapy (eg, atorvastatin 40-80 mg, rosuvastatin 20-40 mg daily) for secondary prevention in all patients age s75 with known ASCVD (moderate-intensity statin therapy is recommended for those age >75), regardless of baseline LDL level.
Statin therapy is also recommended for primary prevention of ASCVD in patients with serum LDL
≥190 mg/dL, age ≥40 with diabetes mellitus, or with an estimated 10-year risk of ASCVD
>7.5%-10% (guidelines vary on the exact cutoff) using the Pooled Cohort Equations risk calculator.
What are the risks of TAGs, LDL, and HDL?
Elevated levels of LDL are known to be atherogenic, while HDL is anti-atherogenic. Triglycerides do not have clear association with atherosclerosis, but at very high levels (> 1000) are associated with pancreatitis.
Hyperlipidemia increases the risk of … ?
Risk factor for coronary disease and stroke.
Lipid deposits can lead to … ?
“xanthelasma,” lipid deposit, commonly of tendon and eyelid.
Corneal arcus (lipid deposit in cornea).
What are the lifestyle modifications for all patients with hyperlipidemia?
- Healthy diet
-Exercise
-Quit smoking
What comorbid condition accelerates atherosclerotic cardiovascular disease (ASCVD) the worst?
diabetes > smoking > hypertension
What comorbid condition accelerates atherosclerotic cardiovascular disease (ASCVD) most commonly?
hypertension
Patients between 40 to 75 who are high risk (DM, smoking, HTN, family history) are managed for atherosclerotic cardiovascular disease by … ?
Getting a statin regardless of LDL levels.
What are the primary preventive measures for statin therapy?
LDL > 190 → High intesity statin
40 to 75 years old with DM → Moderate to High intensity statin
ASCVD risk greater than 7.5% to 10% → Moderate to High statin
When a patient has known ASCVD (CAD, CVA, PAD) what is the measure to manage their dyslipidemia?
They will get a “Secondary Prevention,” which is a High intensity statin.
What are the high intensity statins?
High-intensity statins:
- Atorvastatin 40-80 mg
- Rosuvastatin 20-40 mg;
What are the moderate-intensity statins?
Moderate-intensity statins:
- Atorvastatin 10-20 mg
- Rosuvastatin 5-10 mg
- Simvastatin 20-40 mg
- Pravastatin 40-80 mg
- Lovastatin 40 mg
What is the MOA of statin therapy?
HMG-CoA inhibitor
Once starting statins, what must be done before initiation of treatment and is there a reason to monitor patients?
Obtain baseline LFTs and CK, but no need to screen for LFTs/CK unless symptomatic.
What is the effect of statin on LDL, HDL, and Trig?
Lowers LDL, increases HDL, Lowers Trig.
What effect doest Cholestyramine or Colestipol have on LDLs, HDLs, and Trig?
These will lower LDL, raise HDL, but have no impact on trigs.
What effect does ezetimibe have on LDLs, HDLs, and Trig?
Only lowers LDL.
Gemfibrozil and Fenofibrate have on LDLs, HDLs, and Trig?
These will incresae HDL and decrease trigs.
What effect does niacin have on LDLs, HDLs, and Trig?
Lowers LDL, raises HDL and Lowers Trigs.
What effect does Omega-3 have on LDLs, HDLs, and Trig?
raises HDL and lowers LDL.
What effect do PCSK-9 inhibitors (Evolocumab or Alirocumab) have on LDLs, HDLs, and Trig?
Lowes LDL, raises HDL, lowers trigs
When triglycerides are elvated (in isolation), what is used to drive management?
Whether TGs are between 15 to 500 mg/dL or above 500 mg/dL.
