Hyperlipidemia 2 Flashcards

1
Q

Physical exam- Evidence of____:

–VS: elevated BP? BMI? waist circumference?

–Skin: xanthomas, rashes

–HEENT: corneal arcus, lipemia retinalis, AV nicking?

–Neck: thyroid exam, carotid bruits?

–Lung: adventitious sounds?

–Heart/CV: appropriate PMI? extra sounds?

–Abdomen: hepatomegaly? kidney masses? bruits?

–Extremities: pulses, edema, PAD? foot exam (DM)

–Neuro: evidence of prior “event”? DTRs?

A

Evidence of CVD or secondary causes of hyperlipidemia:

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2
Q

Although pts w/ hyperlipidemia are _____, the following may be seen on physical exam:

–Xanthomatous tendons

–Corneal arcus

–Lipemia retinalis

–Xanthelasma

–Eruptive xanthomas

A

Asymptomatic

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3
Q

The following are the steps of which guideline?

  1. Obtain fasting lipid profile (fast x9-12 hrs)
  2. ID presence of clinical atherosclerotic disease that confers high risk for CHD events (CHD risk equivalent)
  3. Determine presence of major risk factors (other than LDL)
  4. If 2+ risk factors present without CHD or CHD risk equivalent, asses 10-year CHD risk (Framingham)
  5. Determine risk category
  6. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal
  7. Consider adding drug therapy if LDL remains above goal
  8. ID metabolic syndrome and treat, if present, after 3 months of TLC
  9. Treat elevated triglycerides and low HDL
A

NCEP ATP III guidelines

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4
Q

The following are CHD equivalents for step 2 of which guidelines?

CHD equivalents:

  1. Coronary artery disease
  2. Peripheral arterial disease
  3. AAA
  4. DM
A

ATP III guidelines

Step 2: ID presence of clinical atherosclerotic disease that confers high risk for CHD events (CHD risk equivalent)

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5
Q

What are the 5 major risk factors (other than LDL) for Step 3 of the ATP III guidelines

A
  1. Smoking
  2. HTN
  3. HDL < 40 mg/dL
  4. Family history of premature coronary disease
  5. Men > 45 years and women > 55 years
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6
Q

Step 4 of ATP III Guidelines states: If 2+ risk factors present without CHD or CHD risk equivalent, assess 10-year CHD risk (Framingham tables):

>____%= CHD risk equivalent

A

> 20% - CHD risk equivalent

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7
Q

ATP III guidelines step 5 (determine risk category): What is the LDL goal for the following risk categories:

CHD or CHD risk equivalents (10 yr risk >20%)

2+ risk factors (10 yr risk <20%)

A

CHD or CHD risk equivalents (10 yr risk >20%)= <70 mg/dL

2+ risk factors (10 yr risk <20%)= <100 mg/dL

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8
Q

The following recommendations are described as what and are recommended when?

  1. AHA low fat diet, < 30% total calories from fat
    • Saturated fat < 7% of daily calories
    • Fish 2 x per week
  2. Dietary cholesterol intake < 200 mg/day
  3. Increased viscous (soluble) fiber – 10-25 g/day
  4. Add plant stanols/sterols – 2 g/day
  5. Maximizing TLC can reduce LDL 25-30%
  6. Aggressive weight management
  7. Increased physical activity – 30 minutes most days
A

Therapeutic Lifestyle Changes

–> recommended to be initiated in step 6 of ATP III guidelines if LDL is above goal

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9
Q

The following are indications of what therapy if LDL remains above goal:

Indications:

–Simultaneously with TLC for CHD and CHD equivalents

–If LDL levels high after 3 months of TLC

A

Step 7 of ATP III guidelines-

Consider adding DRUG therapy if LDL remains above goal

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10
Q

3 or more of the following are risk factors of what condition?

  • Abdominal obesity
    • Waist circumference > 40” in men
    • Waist circumference > 35” in women
  • Triglycerides > 150 mg/dL
  • Low HDL
    • < 40 mg/dL in men
    • < 50 mg/dL in women
  • Increased blood pressure (>130/>85 mmHg)
  • Impaired fasting glucose is > 100 mg/dL
A

Metabolic syndrome

Step 8 of ATP III guidelines: ID metabolic syndrome and treat, if present, after 3 months of TLC

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11
Q

What waist circumfrence in men vs. women is considered a risk factor for metabolic syndrome

A

Men= >40”

Women= >35”

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12
Q

What HDL levels in men vs women are considered risk factors for metabolic syndrome?

A

LOW HDL:

Men= <40mg

Women= <50mg

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13
Q

What BP is considered a risk factor of metabolic syndrome

A

>130/>85

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14
Q

What fasting glucose reading is considered a risk factor of metabolic syndrome?

A

>100

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15
Q

In step 9 of ATPIII guidelines, the primary aim of drug therapy is to reach_____ goal

A

LDL

*Want to first reach LDL goal and can use intensive TLC to increase HDL

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16
Q

What can be recommended to intensify TLC in order to increase HDL in step 9 of ATP III guidelines?

(step 9= tx elevated TG and low HDL)

A

–Remember exercise?

–Increase Monounsaturated fats

–Smoking cessation

–Moderate EtOH use (1-2 drinks/day)

17
Q

In step 9 of ATP III guidelines, what do you do if TG is >200 mg/dL?

A

–Maximize statin therapy, then

–Consider Rx with non-statins

18
Q

The following are major ASCVD events for which guidelines:

  1. Acute coronary syndrome (within past 12 months)
  2. Hx of MI
  3. Hx of ischemic stroke
  4. Symptomatic PAD
    • Claudication with ABI < 0.85
    • Previous revascularization surgery
    • Amputation
A

ACC/AHA guidelines

19
Q

According to ACC/AHA guidelines, what classifies as symptomatic PAD (a major ASCVD event)?

A
  • Claudication with ABI < 0.85
  • Previous revascularization surgery
  • Amputation
20
Q

What 2 meds are considered high-intensity statins?

A

Atorvastatin (40mg) 80mg

Rosuvastatin 20 (40mg)

These lower LDL by greater than or equal to 50%

21
Q

How much do high-intensity statins lower LDL by?

A

greater than or equal to 50%

22
Q

What are instensity are the following statins:

Atorvastatin 10mg (20mg)

Rosuvastatin (5mg) 10mg

Simvastatin 20-40mg

Pravastatin 40mg (80mg)

Lovastatin 40mg (80mg)

Fluvastatin XL (80mg)

Fluvastatin 40mg BID

Pitavastatin 1-4mg

A

Moderate-intensity

These lower LDL by 30-49%

23
Q

The following statins are considered what level of intensity and lower LDL by <30%:

Simvastatin 10mg

Pravastatin 10-20mg

Lovastatin 20mg

Fluvastatin 20-40mg

A

Low instensity statins

24
Q

How much do low intensity statins lower LDL by?

A

<30%