LDL Parameters & Tx

Question 0

1) Adults 21 years or older with LDL cholesterol values at _____mg/dl or more should be treated to achieve at least a ____% reduction in LDL cholesterol levels.

Answer 0

1) 190mg/dl
2) 50% reduction

No recommendations exist regarding specific target levels for LDL cholesterol or non-HDL cholesterol levels. If a statin is insufficient to achieve this goal, other medications may be added.

Question 1

LDL level for DM should be below…

Answer 1

<70 mg/dl

Question 2

1) The guidelines recommend intensive or moderate statin therapy for at-risk patients. Intensive therapy includes which 2 statins & their doses, that may be used daily?

Answer 2

1) atorvastatin (Lipitor) 80 mg and

2) rosuvastatin (Crestor) 20 mg

Question 3

Moderate-intensity daily statin therapy includes tx with which statins & their doses?

Answer 3

1) atorvastatin (Lipitor)10 mg daily; (high intensity drug but at a mod intensity dose)
2) rosuvastatin (Crestor)10 mg daily; (high intensity drug but at a mod intensity dose)
3) simvastatin (Zocor) 20 to 40 mg daily;
4) pravastatin (Pravachol) 40 mg daily;
5) lovastatin (mevacor) 40 mg daily, or
6) fluvastatin (Lescol) 40 mg twice daily.

Question 4

Which pt’s qualify for Intensive statin therapy? (3 answers)

Answer 4

1) Those in need of secondary prevention of cardiovascular disease (already have CVD);
2) baseline LDL cholesterol levels of more than 190 mg/dL.
3) pt’s with elevated r/f CV events based on the Pooled Cohort Equations may receive moderate or intensive statin therapy.

Question 5

Adults between _______years old with LDL cholesterol levels between _______mg/dL and _________may receive moderate-intensity statin therapy.

Answer 5

1) 40 and 75 years old
2) 70 and 189 mg/dL
3) diabetes may receive moderate-intensity statin therapy.

Question 6

When should a repeat lipid panel be performed after the initiation so statin therapy?

Answer 6

4-12 weeks after initiation to ensure compliance and positive effects of medication.

Question 7

LDL Cholesterol – what # is the Primary Target of Therapy?

Answer 7

LDL Cholesterol – Optimal Primary Target of Therapy is
<100 mg/dl.

Question 8

What LDL level is Near optimal/above optimal?

Answer 8

100-129 Near optimal/above optimal

Question 9

What LDL levels are considered borderline high?

Answer 9

130-159 mg/dl Borderline high

Question 10

What LDL levels are considered high?

Answer 10

160-189 mg/dl

Question 11

What LDL levels are considered very high?

Answer 11

190 mg/dl and greater are considered Very high

Question 12

If triglycerides are 200-499 mg/dL after LDL goal is reached, what should be considered?

Answer 12

consider adding a drug if needed to reach non-HDL goal:
• intensify therapy with LDL-lowering drug, or
• add nicotinic acid or fibrate to further lower VLDL

Question 13

1) Name the 3 Commonly used fibrate medications & their starting doses.
2) When are fibrates absolutely contraindicated?

Answer 13

1) a) gemfibrozil 600mg BID
b) fenofibrate 200mg daily
c) clofibrate 1000mg BID

2) severe liver or renal disease

Question 14

When are nicotinic acids contraindicated?

Answer 14

Absolutely contraindicated:
*Chronic liver disease
• Severe gout
Relatively contraindicated:
• Diabetes (med increases blood sugars)
• Hyperuricemia (gout) (can also cause gout)
• Peptic ulcer disease

Question 15

Treatment of low HDL cholesterol (<40 mg/dL)

Answer 15

A) First reach LDL goal, then
B) Increase PT & Wt therapy (TLC), then/or
C) if triglycerides are 200-499 mg/dL, achieve non-HDL goal and/or
D) if triglycerides <200 mg/dL (isolated low HDL) in CHD or CHD equivalent, consider nicotinic acid or fibrate.

Question 16

When should fibrates and nicotinic acids be considered?

Answer 16

1) lowering triglyceride levels (lowers 20-50%),
2) elevating isolated HDL levels (<40 mg/dl),
3) to achieve non-HDL cholesterol level 30 mg/dl higher than LDL.