Lipid Lowering Drugs

Question 1

Statins- Mechanism

Answer 1

1. Inhibit HMG CoA reductase (therefore inhibiting synthesis
2. Decrease hepatic pool of free cholesterol
3. Increase expression of LDL receptors
4. Increase catabolism of VLDL and LDL
5. Decrease LDL contraction

Question 2

Statins- downsides

Answer 2

AST and ALT abnormalities (though not a major liver tool)
Myopathy
Cognitive impairment (not really)

Question 3

Statins- Guidelines

Answer 3

Previous ASCVD: high intensity

LDL >190 without secondary cause: high intesnsity

Primary prevention (diabetes, 40-75, LDL 70-189): moderate or high intensity

Primary prevention (No diabetes, age 40-75, LDL 70-189, 7.5% risk of CVD in next ten years): moderate

Question 4

Bile Acid Sequestrants

Answer 4

Inhibit reabsorption of bile acids
Stimulates LDL receptor
Stimulates LDL uptake by liver
TGs can go up, there are GI side effects and it can inhibit Rx absorption

Question 5

Plant sterols esters

Answer 5

Inhibits cholesterol absorption. May inhibit vitamin absorption. No clinical evidence

Question 6

Ezetimibe

Answer 6

Selective cholesterol absorption inhibitors. No side effects

Question 7

Fibrates

Answer 7

Lower TG
Targets liver
Increases FA oxidation
Causes skin rash, myopathy, increase LFT. benefit when TG is above 200

Question 8

Omega 3-FA

Answer 8

Lowers TG
Decreases hepatic TG production and therefore decreases VLDL and TG secretion
Indicated when TG are above 500

Question 9

Niacin

Answer 9

Decreases LDL and TG and increases HDL
Works in adipose tissue, binds to inhibitors receptor. Lots of side effects: flushing, liver disease, Peptic ulcer disease, gouth, IBD

Question 10

CETP

Answer 10

“best” HDL raiser (can raise by 200%) but poor results in trials

Question 11

Whats the best way to raise HDL?

Answer 11

Lifestyle!