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ADA 24 > LIPID MANAGMENT > Flashcards

LIPID MANAGMENT Flashcards

1
Q

What is the recommended initial steps for patients with statin intolerance?

A

Switching statins or lowering doses and consider non-daily dosing.

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2
Q

Which nonstatin treatments can be added to improve adherence and LDL cholesterol goal achievement?

A

Alirocumab, evolocumab, Bempedoic Acid, Inclisiran.

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3
Q

What fasting triglyceride levels warrant evaluation for secondary causes of hypertriglyceridemia?

A

Levels ≥500 mg/dL (≥5.7 mmol/L).

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4
Q

In individuals with controlled LDL cholesterol but elevated triglycerides, what additional medication can be considered?

A

Icosapent ethyl to reduce cardiovascular risk.

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5
Q

For individuals with severe cases of high fasting triglycerides, what is required?

A

Medication and reduction in dietary fat to prevent acute pancreatitis.

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6
Q

What percentage reduction in cardiovascular events was observed in the REDUCE-IT trial with Icosapent ethyl?

A

25% compared to placebo.

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7
Q

Why is statin and fibrate combination therapy generally not recommended?

A

It is associated with increased risk of abnormal transaminase levels, myositis, and rhabdomyolysis.

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8
Q

Why is statin and niacin combination therapy not advised?

A

Ineffectiveness on major ASCVD outcomes and increased side effects.

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9
Q

What cardiovascular risk may be slightly increased with statin use?

A

Type 2 diabetes risk, especially in those already at risk.

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10
Q

What lifestyle modifications are recommended for improving lipid profiles in individuals with diabetes?

A

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.

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11
Q

When should a lipid profile be obtained for adults with prediabetes or diabetes not on statins?

A

At the time of diagnosis, initial medical evaluation, annually thereafter, or more frequently if indicated.

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12
Q

What is the recommended statin therapy for individuals with diabetes aged 40-75 years without ASCVD?

A

Use moderate-intensity statin therapy in addition to lifestyle therapy.

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13
Q

What is the goal When should high-intensity statin therapy be used for individuals with diabetes aged 40-75 years at higher cardiovascular risk?

A

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.

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14
Q

In individuals aged 40-75 years with diabetes and multiple ASCVD risk factors, what therapy may be added to statins?

A

Ezetimibe or a PCSK9 inhibitor may be added to maximum tolerated statin therapy.

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15
Q

What is the recommended course of action for adults with diabetes aged >75 years already on statin therapy?

A

Continue statin treatment.

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16
Q

What is the recommended treatment for individuals with diabetes intolerant to statin therapy?

A

Bempedoic acid is recommended to reduce cardiovascular event rates as an alternative cholesterol-lowering plan.

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17
Q

Is statin therapy contraindicated in pregnancy?

A

Yes, statin therapy is contraindicated in pregnancy.

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18
Q

What type of statin therapy should be added to lifestyle therapy for individuals of all ages with diabetes and ASCVD risk factors?

A

High-intensity statin therapy should be added.

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19
Q

What LDL cholesterol level is considered acceptable? In general low risk DM Pt?

A

LDL cholesterol level <100 mg/dL (<2.6 mmol/L).

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20
Q

What is the recommended cholesterol limit per day?

A

Limit cholesterol intake to <200 mg/day.

21
Q

What percentage should saturated fat be limited to?

A

Limit saturated fat to <7% of total calories.

22
Q

When should a statin be considered for addition in youth with type 1 diabetes?
What are LDL LEVELS in pediatrics?

A

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.

23
Q

What is the LDL cholesterol goal for individuals under 40 with diabetes or ASCVD risk factors?

A

LDL cholesterol goal <100 mg/dL (<2.6 mmol/L) is recommended.

24
Q

What is the recommended LDL cholesterol reduction percentage for people with diabetes and ASCVD using high-intensity statin therapy?

A

Target an LDL cholesterol reduction of ≥50% from baseline.

25
Q

When is the addition of ezetimibe or a PCSK9 inhibitor recommended in statin therapy?

A

Addition is recommended if LDL cholesterol goal is not achieved on maximum tolerated statin therapy.

26
Q

What was the LDL cholesterol reduction percentage shown when adding PCSK9 inhibitors to statin therapy in high-risk ASCVD patients?

A

An average reduction of 36-59% in LDL cholesterol.

27
Q

What is the effect of evolocumab, a PCSK9 inhibitor, on reducing LDL cholesterol?

A

Evolocumab reduced LDL cholesterol by 59% (FOURIER TRIAL).

28
Q

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?

A

21% reduction in major cardiovascular events for every 39 mg/dL (1 mmol/L) reduction in LDL cholesterol.
((( was statin effect)))

29
Q

What LDL cholesterol reduction percentage is recommended in people with diabetes and ASCVD?

A

≥50%

30
Q

What is the LDL cholesterol goal for people with diabetes and active ASCVD?

A

<55 mg/dL (<1.4 mmol/L)

31
Q

Which additional therapy is recommended if LDL cholesterol goal is not achieved on maximum tolerated statin therapy?

A

Ezetimibe or PCSK9 inhibitor

32
Q

What is the recommended statin intensity for people who do not tolerate the intended intensity?

A

Maximum tolerated statin dose

33
Q

In individuals intolerant to statin therapy for diabetes and ASCVD, what alternative therapy is recommended?

A

PCSK9 inhibitor therapy with monoclonal antibody treatment, bempedoic acid, or inclisiran siRNA

34
Q

What was the reduction in all-cause mortality shown in meta-analyses of statin therapy trials?

A

9%

35
Q

What LDL cholesterol reduction should high-intensity statin therapy aim for in people with diabetes at higher cardiovascular risk?
No active ACVD

A

≥50% from baseline to target <70 mg/dL

36
Q

What effect did alirocumab have when added to statin therapy?

A

Reduced LDL cholesterol by 62% and major adverse cardiovascular events

37
Q

What is the age recommendation for moderate-intensity statin therapy in individuals aged ≥75?

A

Moderate-intensity statin therapy with dose adjustments

38
Q

What criteria are suggested for type 1 diabetes with high cardiovascular risk?
If has how many risk factors?

A

Duration of disease > 15 years, presence of 2 major cardiovascular risk factors

39
Q

When should the initial lipid profile be performed for children with dyslipidemia?
At what age of adulthood?

A

Preferably after glycemia has improved and age is ≥22 years

40
Q

When should subsequent testing be performed in children with LDL cholesterol ≤100 mg/dL?

A

At 9-11 years of age

41
Q

What type of testing may be done initially for children with dyslipidemia?
Fasting or not?

A

Nonfasting lipid level with confirmatory testing with a fasting lipid panel

42
Q

What lifestyle interventions are recommended for dyslipidemia?

A

Increase dietary fiber, healthy fat; decrease saturated fat, simple carbs, added sugars; engage in physical activity.

43
Q

Which major risk factors are considered in the ASCVD 10-year risk calculator?
7 items

A

Age >40, Hypertension (HTN), Chronic Kidney Disease (CKD) >3a, Smoking, Family History of Premature ASCVD, Low HDL-C, High Non-HDL-C.

44
Q

When is statin therapy initiated for high-risk individuals?
How many risk factors?
AACE

A

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.

45
Q

What are the criteria for extreme-risk individuals to initiate statin therapy?
AACE

A

Extreme risk individuals include those with ASCVD and T2D, severe target organ damage, eGFR <45 , UACR >300, ABI <0.9, LV dysfunction.

46
Q

How is hypertriglyceridemia managed for very high-risk individuals?
At what level TG?
AACE

A

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.

47
Q

What interventions are recommended for elevated triglycerides causing acute pancreatitis?

A

For triglycerides >500 mg/dL to >1000 mg/dL causing acute pancreatitis, urgent intervention with dietary management and fibrate/omega-3 therapy is needed.

48
Q

What should be considered for severe hypertriglyceridemia refractory to previous interventions?

A

For severe hypertriglyceridemia >1000 refractory to previous interventions, consider niacin to reduce the risk of pancreatitis.

49
Q

By how much does ezetimibe reduce LDL?
As mon and combination therapy?

A

Ezetimibe lowers LDL levels by about 18% when used as monotherapy and by an additional 25% when added to statin therapy.

ADA 24 (2 decks)

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