Lipid Large group

Question 1

What are the 4 indications for Statin therapy?

Answer 1

Known clinical ASCVD

LDL-C >= 190 mg/ dl

Diabetics, 40-75 yo, LDL-C 70-189

Nondiabetics, LDL-C 70-189, 10 yr risk > 7.5%

Question 2

What are the 4 foci of lifestyle changes in ASCVD reduction?

Answer 2

Heart healthy Diet

Regular Exercise

Avoid Tobacco

Maintain a Healthy Weight

Question 3

with a pt with no PMHx of clinical ASCVD, and IF he is shown not to have diabetes or hypertension, what would his fasting LDL-C have to be for us to consider statin therapy according to the 2013 ACC/ AHA Guidelines?

Answer 3

> = 190 mg/dl

Question 4

What statins are most commonly used? What is the recommended dose?

Answer 4

Atorvastatin (40-80mg) or Rosuvastatin (20-40)

pt’s should be treated with the maximum appropriate intensity of a statin (high dose)

Question 5

In what conditions would statins be given at a moderate dose rather than a high dose?

Answer 5

> 75 yo

DM 40-75 yo

all other should be treated with HIGH dose statins

Question 6

What is the goal LDL for a person being treated for ASCVD? When would you consider lowering the dose?

Answer 6

-no goal–> check to verify efficacy, adverse reactions

death (begin to reduce at age 75)

with a hx of ASCVD, should be on lifelong statins

Question 7

What tests should you order in a follow up for a pt being treated for ASCVD?

Answer 7

Lipids: see if meds are working

LFT’s (2-3x normal): if signs of liver fxn

CK: look for rhabdo

Question 8

What findings do you expect on the fasting lipid panel of a pt with familial hypercholesterolemia?

Answer 8

total cholesterol 300-600 mg/dl

LDL-C >200 mg/dl

Question 9

What is another name for familial hypercholesterolemia? What is the underlying defect in this?

Answer 9

Type II A hyperlipidemia

genetic mutation causing a loss of function in the LDL receptors

Question 10

What should the treatment for familial hypercholesterolemia be?

Answer 10

statin therapy should be HIGH

lifestyle modifications

yearly checks

additional medications if necessary

Question 11

What is included in the ASCVD risk calculator?

Answer 11

gender
age 
race 
total cholesterol 
SBP
HDL-C
LDL-C
smoker 
diabetes
HTN meds

Question 12

What are some risks of statins?

Answer 12

GI upset, rash, allergies, liver irritation, rhabdomyolysis, myalgia, dry skin/eyes (high dose fish oil could take this away), decreased hormones, nerve function, cost drug interactions

Question 13

What are some other benefits of statins?

Answer 13

decreased incidence of alzheimer’s

decreased incidence of certain cancers

plaque stabilization

Question 14

What percentage of cholesterol is produced by the liver? Obtained through the diet?

Answer 14

75% produced by liver

25% from diet

Question 15

How is cholesterol normally removed from the body?

Answer 15

stool