Hyperlipidemia

Question 1

Mechanism of statin

Answer 1

b hydroxy b methylgutarl coenzyme A inhibitor (HMG-CoA) reductase inhibitor; most widely used med to lower LDL

Question 2

Statins should be implemented in all patients with known cardiovascular disease (i.e. ASCVD; atherosclerotic cv disease) and/or with LDL greater than ____?

Answer 2

190

Question 3

Statins should be implemented in patients with (what condition) and LDL cholesterol greater than _____?

Answer 3

DM; 70

Question 4

Statins should be started n patients aged 40-75 with _____year CVD risk greater than or equal to ____% and LDL greater than _____

Answer 4

10 year; 7.5%, 70

Question 5

Despite all these guidelines and recommendations; decision to start statin therapy should ultimately depend on….

Answer 5

individual risk factors

Question 6

What tools are out there that can assess for coronary disease

Answer 6

QRISK, ASSIGN, QRISK2

Question 7

Goal for HDL cholesterol

Answer 7

60 or greater

Question 8

When to be concerned about low HDL

Answer 8

less than 40

Question 9

Desirable, borderline, high total cholesterol

Answer 9

desirable 240

Question 10

optimal, near optimal, borderline, high, very high LDL

Answer 10

optimal 190

GO BY 30s starting from 100!

Question 11

secondary causes of dyslipidemia

Answer 11

DM, hypothyroidism, obstructive liver disease, chronic renal failure

Question 12

how to work up secondary causes of dyslipidemia (labs)

Answer 12

fasting blood glucose, TSH, liver enzymes, creatinine level

Question 13

What kinds of medications can increase cholesterol

Answer 13

progestins, anabolic steroids and corticosteroids

Question 14

What are the cornerstone of all treatments of HLD

Answer 14

lifestyle modifications!

healthy diet, regular exercise, smoking cessation, weight control

Question 15

Recommend a healthy diet for cholesterol management

Answer 15

Rich in fruits and veggies
whole-grain/high fiber foods
fish, especially oily fish at least twice a week
minimize added sugars and sugary beverages
low salt foods and low fat (especially trans-fat and saturated fats –> favor polyunsaturated fat)
adding in dietary soluble fiber may be beneficial

always offer to refer to dietician

Question 16

In addition to lowering LDL, what added beneifts are there to statins?

Answer 16

reduce rates of coronary events, strokes, cardiac death, and all-cause mortality

Question 17

If patient cannot tolerate statins, what’s a good alternative?

Answer 17

Ezetimibe

Question 18

Who should get evaluated for secondary causes of hyperlipidemia

Answer 18

Anyone with LDL over 190 or triglycerides over 500

Question 19

Side effects of statins

Answer 19

myopathy, myalgia, increased liver enzymes

Question 20

Which labs should be trended when starting statin therapy?

Answer 20

liver enzymes

Question 21

contraindications to statins

Answer 21

active/chronic liver disease, relative contraindication with cytochrome P-450 inibitors, cyclosporine, macrolides, antifungals

Question 22

What other treatment options are there besides statins and ezetimibe (cholesterol absorber)

Answer 22

nicotinic acids, bile acid sequestrants (cholestyramine), monoclonal antibodies (evolocumab), fibric acids (gemfibrozil)