LIPID MANAGMENT Flashcards
What is the recommended initial steps for patients with statin intolerance?
Switching statins or lowering doses and consider non-daily dosing.
Which nonstatin treatments can be added to improve adherence and LDL cholesterol goal achievement?
Alirocumab, evolocumab, Bempedoic Acid, Inclisiran.
What fasting triglyceride levels warrant evaluation for secondary causes of hypertriglyceridemia?
Levels ≥500 mg/dL (≥5.7 mmol/L).
In individuals with controlled LDL cholesterol but elevated triglycerides, what additional medication can be considered?
Icosapent ethyl to reduce cardiovascular risk.
For individuals with severe cases of high fasting triglycerides, what is required?
Medication and reduction in dietary fat to prevent acute pancreatitis.
What percentage reduction in cardiovascular events was observed in the REDUCE-IT trial with Icosapent ethyl?
25% compared to placebo.
Why is statin and fibrate combination therapy generally not recommended?
It is associated with increased risk of abnormal transaminase levels, myositis, and rhabdomyolysis.
Why is statin and niacin combination therapy not advised?
Ineffectiveness on major ASCVD outcomes and increased side effects.
What cardiovascular risk may be slightly increased with statin use?
Type 2 diabetes risk, especially in those already at risk.
What lifestyle modifications are recommended for improving lipid profiles in individuals with diabetes?
Weight loss (if indicated), Mediterranean or DASH eating pattern, reduction of saturated and trans fat, increase n-3 fatty acids, viscous fiber, plant fiber, stanol/sterol intake, and increased physical activity.
When should a lipid profile be obtained for adults with prediabetes or diabetes not on statins?
At the time of diagnosis, initial medical evaluation, annually thereafter, or more frequently if indicated.
What is the recommended statin therapy for individuals with diabetes aged 40-75 years without ASCVD?
Use moderate-intensity statin therapy in addition to lifestyle therapy.
What is the goal When should high-intensity statin therapy be used for individuals with diabetes aged 40-75 years at higher cardiovascular risk?
For those with one or more ASCVD risk factors, it is recommended to use high-intensity statin therapy to reduce LDL cholesterol by ≥50% of baseline with a target of <70 mg/dL.
In individuals aged 40-75 years with diabetes and multiple ASCVD risk factors, what therapy may be added to statins?
Ezetimibe or a PCSK9 inhibitor may be added to maximum tolerated statin therapy.
What is the recommended course of action for adults with diabetes aged >75 years already on statin therapy?
Continue statin treatment.
What is the recommended treatment for individuals with diabetes intolerant to statin therapy?
Bempedoic acid is recommended to reduce cardiovascular event rates as an alternative cholesterol-lowering plan.
Is statin therapy contraindicated in pregnancy?
Yes, statin therapy is contraindicated in pregnancy.
What type of statin therapy should be added to lifestyle therapy for individuals of all ages with diabetes and ASCVD risk factors?
High-intensity statin therapy should be added.
What LDL cholesterol level is considered acceptable? In general low risk DM Pt?
LDL cholesterol level <100 mg/dL (<2.6 mmol/L).
What is the recommended cholesterol limit per day?
Limit cholesterol intake to <200 mg/day.
What percentage should saturated fat be limited to?
Limit saturated fat to <7% of total calories.
When should a statin be considered for addition in youth with type 1 diabetes?
What are LDL LEVELS in pediatrics?
Consider addition of a statin if LDL cholesterol >160 mg/dL (>4.1 mmol/L) or >130 mg/dL (>3.4 mmol/L) with cardiovascular risk factors.
What is the LDL cholesterol goal for individuals under 40 with diabetes or ASCVD risk factors?
LDL cholesterol goal <100 mg/dL (<2.6 mmol/L) is recommended.
What is the recommended LDL cholesterol reduction percentage for people with diabetes and ASCVD using high-intensity statin therapy?
Target an LDL cholesterol reduction of ≥50% from baseline.
When is the addition of ezetimibe or a PCSK9 inhibitor recommended in statin therapy?
Addition is recommended if LDL cholesterol goal is not achieved on maximum tolerated statin therapy.
What was the LDL cholesterol reduction percentage shown when adding PCSK9 inhibitors to statin therapy in high-risk ASCVD patients?
An average reduction of 36-59% in LDL cholesterol.
What is the effect of evolocumab, a PCSK9 inhibitor, on reducing LDL cholesterol?
Evolocumab reduced LDL cholesterol by 59% (FOURIER TRIAL).
What percentage of reduction in major adverse cardiovascular events (MACE) is associated with a decrease of 39 mg/dL (1 mmol/L) in LDL cholesterol levels?
21% reduction in major cardiovascular events for every 39 mg/dL (1 mmol/L) reduction in LDL cholesterol.
((( was statin effect)))
What LDL cholesterol reduction percentage is recommended in people with diabetes and ASCVD?
≥50%
What is the LDL cholesterol goal for people with diabetes and active ASCVD?
<55 mg/dL (<1.4 mmol/L)
Which additional therapy is recommended if LDL cholesterol goal is not achieved on maximum tolerated statin therapy?
Ezetimibe or PCSK9 inhibitor
What is the recommended statin intensity for people who do not tolerate the intended intensity?
Maximum tolerated statin dose
In individuals intolerant to statin therapy for diabetes and ASCVD, what alternative therapy is recommended?
PCSK9 inhibitor therapy with monoclonal antibody treatment, bempedoic acid, or inclisiran siRNA
What was the reduction in all-cause mortality shown in meta-analyses of statin therapy trials?
9%
What LDL cholesterol reduction should high-intensity statin therapy aim for in people with diabetes at higher cardiovascular risk?
No active ACVD
≥50% from baseline to target <70 mg/dL
What effect did alirocumab have when added to statin therapy?
Reduced LDL cholesterol by 62% and major adverse cardiovascular events
What is the age recommendation for moderate-intensity statin therapy in individuals aged ≥75?
Moderate-intensity statin therapy with dose adjustments
What criteria are suggested for type 1 diabetes with high cardiovascular risk?
If has how many risk factors?
Duration of disease > 15 years, presence of 2 major cardiovascular risk factors
When should the initial lipid profile be performed for children with dyslipidemia?
At what age of adulthood?
Preferably after glycemia has improved and age is ≥22 years
When should subsequent testing be performed in children with LDL cholesterol ≤100 mg/dL?
At 9-11 years of age
What type of testing may be done initially for children with dyslipidemia?
Fasting or not?
Nonfasting lipid level with confirmatory testing with a fasting lipid panel
What lifestyle interventions are recommended for dyslipidemia?
Increase dietary fiber, healthy fat; decrease saturated fat, simple carbs, added sugars; engage in physical activity.
Which major risk factors are considered in the ASCVD 10-year risk calculator?
7 items
Age >40, Hypertension (HTN), Chronic Kidney Disease (CKD) >3a, Smoking, Family History of Premature ASCVD, Low HDL-C, High Non-HDL-C.
When is statin therapy initiated for high-risk individuals?
How many risk factors?
AACE
Initiate statin therapy for individuals at high risk with ASCVD risk <10%, T2D <10 years, or <2 other risk factors and no target organ damage.
What are the criteria for extreme-risk individuals to initiate statin therapy?
AACE
Extreme risk individuals include those with ASCVD and T2D, severe target organ damage, eGFR <45 , UACR >300, ABI <0.9, LV dysfunction.
How is hypertriglyceridemia managed for very high-risk individuals?
At what level TG?
AACE
For very high-risk individuals with TG 135-199, TG 200-499, or TG ≥500, intensify lifestyle, achieve glycemic targets, use statins, and consider additional therapies.
What interventions are recommended for elevated triglycerides causing acute pancreatitis?
For triglycerides >500 mg/dL to >1000 mg/dL causing acute pancreatitis, urgent intervention with dietary management and fibrate/omega-3 therapy is needed.
What should be considered for severe hypertriglyceridemia refractory to previous interventions?
For severe hypertriglyceridemia >1000 refractory to previous interventions, consider niacin to reduce the risk of pancreatitis.
By how much does ezetimibe reduce LDL?
As mon and combination therapy?
Ezetimibe lowers LDL levels by about 18% when used as monotherapy and by an additional 25% when added to statin therapy.
