Hyperlipidemia

Question 1

Screening guidelines
NIH
ATP III

Criteria to perform Fasting full lipid panel:

Answer 1

NIH (2011) recommends screening all ages 9-11 and again at 17-21 years

Screen at age 20 and then every 5 years
Non-fasting Total Cholesterol with HDL

No Cardiac Risk Factors: 
Total-C >240 mg/dl
Cardiac Risk Factors: 
Total-C >200 mg/dl 
HDL

Question 2

Screening guidelines
NIH
ATP III

Criteria to perform Fasting full lipid panel:

Answer 2

NIH (2011) recommends screening all ages 9-11 and again at 17-21 years

Screen at age 20 and then every 5 years
Non-fasting Total Cholesterol with HDL

No Cardiac Risk Factors: 
Total-C >240 mg/dl
Cardiac Risk Factors: 
Total-C >200 mg/dl 
HDL

Question 3

LDL

Total cholesterol

HDL

Answer 3

LDL 190 very high

Total cholesterol 240 high

HDL 40-60

Question 4

Triglyceride levels

Question 5

LDL

Question 6

LDL level if CVD

Answer 6

70

Question 7

new medication choice strategy

Answer 7

not based on ldl goal

Question 8

LDL measurement with statin therapy

when to decrease intensity

Answer 8

-monitor high risk, adherence, and to see if too low

Adherence confirmation in patients who do not have an appropriate drop or an increase in cholesterol levels

Decrease the intensity of therapy in patients whose LDL

Question 9

Moderate intensity statins

Answer 9

Lovastatin 40 mg
Pravastatin 40 - 80 mg
Simvastatin 20 - 40 mg
Atorvastatin 10 - 20 mg
Rosuvastatin 5 - 10 mg

Question 10

High intensity statins

Answer 10

Atorvastatin 40 to 80 mg

Rosuvastatin 20 to 40 mg

Question 11

Patients with >25% 10 year risk treat with…

Answer 11

high intensity

Question 12

Treat with mod-high intensity statin instead of

Answer 12

LDL goal

Question 13

Cardiac risk factors

Answer 13

Age Men >45 Women >55 (normal onset menopause) >45 (early menopause)
Tobacco Use Current or w/i 5 years
HTN BP >140/90 Antihypertensive med
Hyperlipidemia LDL >130 HDL

Question 14

LDL

Total cholesterol

HDL

Answer 14

LDL 190 very high

Total cholesterol 240 high

HDL 40-60

Question 15

Triglyceride levels

Question 16

Estimating 10 year risk aka
Low
mod
high

Answer 16

aka framingham risk score

low

Question 17

LDL level if CVD

Answer 17

70

Question 18

new medication choice strategy

Answer 18

not based on ldl goal

Question 19

LDL measurement with statin therapy

when to decrease intensity

Answer 19

-monitor high risk, adherence, and to see if too low

Adherence confirmation in patients who do not have an appropriate drop or an increase in cholesterol levels

Decrease the intensity of therapy in patients whose LDL

Question 20

Moderate intensity statins

Answer 20

Lovastatin 40 mg
Pravastatin 40 - 80 mg
Simvastatin 20 - 40 mg
Atorvastatin 10 - 20 mg
Rosuvastatin 5 - 10 mg

Question 21

High intensity statins

Answer 21

Atorvastatin 40 to 80 mg

Rosuvastatin 20 to 40 mg

Question 22

Patients with >25% 10 year risk treat with…

Answer 22

high intensity

Question 23

Treat with mod-high intensity statin instead of

Answer 23

LDL goal

Question 24

Cardiac risk factors

Answer 24

Age Men >45 Women >55 (normal onset menopause) >45 (early menopause)
Tobacco Use Current or w/i 5 years
HTN BP >140/90 Antihypertensive med
Hyperlipidemia LDL >130 HDL

Answer 25

GOAL 160- low fat diet >190- antihyperlipidemic if desirable- q 5 years borderline- 1 year elevated 3-6 months

Question 26

>2 cardiac risk factors (LDL goal and mgt) monitoring: desirable borderline elevated

Answer 26

LDL goal 130- low fat diet and hyperlipidemic agent if LDL >130 with FRS 20% or >160 desirable: 1-2 years borderline: repeat 6 months elevated: every 2-3 months

Question 27

``` Management CAD (DM FRS 20% or higher AAA PVD carotid disease) Goal LDL and management ``` monitoring desirable: borderline: elevated:

Answer 27

goal ldl then low fat diet plus hyperlipidemic for LDL>130 desirable: every 6-12 months borderline: every 2-3 months elevated: every 6 weeks

Question 28

Primary prevention is for those without CVD age___ to ____ without known CVD and LDL ___ to ____ with DM without DM

Answer 28

40-75 without known CVD LDL 70-189 with DM: at least mod, >7.5% then HIGH without DM: 5-7.5 mod and >7.5 mod to high

Question 29

Secondary prevention for those with

Answer 29

CAD cerebrovascular peripheral disease | 10 year risk >20, CKD and GFR

Question 30

Previous MI 20x risk of

Answer 30

death from CAD

Question 31

Adjunct tx with statins?

Answer 31

not recommended unless trig> 500 or statins not tolerated

Question 32

Statins >75?

Answer 32

continue tx if CAD, high coronary calcium or ankle brachial index

Question 33

HIgh intensity

Answer 33

LDL>190 CVD DM age 40-50 esp >7.5

Question 34

Moderate intensity

Answer 34

10 year >7.5 | DM age

Question 35

Weight loss amount rec. | biggest effect on

Answer 35

24 lb | trig

Question 36

Complementary therapies

Answer 36

Garlic Plant Sterols (e.g. Benecol, Promise Activ) Fish oils (Omega-3 Fatty Acids) Lowers Triglycerides (4%: 1 g/day, 10-40%: 2-4g/day) marg. effect HDL, raises LDL Soluble Dietary Fiber (Lowers LDL Cholesterol 7% for 10 grams of fiber) Dietary Soy Proteins 25 grams per day (4% lowering) Unsaturated fat nuts Glucophage (Metformin) Rosiglitazone or Pioglitazone Red-yeast rice(Contains natural HMG-CoA reductase agent) Currently unregulated and dose not standardized

Question 37

HDL risk factor if

Answer 37

35 increase: gemfibrozil, niacin, mod etoh, aerobic exercise, weight loss decreaseL tobacco, DM, high trig, menopause, obesity, steroids, liver disease, progestins

Question 38

LDL risk factor level | increases LDL:

Question 39

triglycerides level | level risk factor for CVD

Answer 39

500 | >300 and HDL

Question 40

``` triglyceride mgt 150-199 borderline 200-499 high 500 very high* 1000 highest ```

Answer 40

borderline- lifestyle high- + LDL 1st + fibrate, poss fish oil (****very high- first line is fibrate (tricor, gemfibrozil) do not worry about LDL at this point) second line is niacin >1000 agg weight loss, lowww fat diet, ? secondary cause

Question 41

Statins lab

Answer 41

baseline ALT aminotransferase | baseline CK may be useful

Question 42

Least likely statins to cause myalgias

Answer 42

pravastatin fluvastatin