lipid modification Flashcards
effective dietary changes for improving lipid concentrations
reducing alcohol intake
reducing intake of saturated and trans fats
replacing saturated fats with unsaturated fats
increasing intake of fibre
introducing plant sterol-enriched milk, margerine or cheese products
if LDL-c target is not met with statin therapy alone
consider adding ezetemibe
consider adding PCSK9 inhibitor
when should you see the patient again to review their cholesterol
6 weeks
statins for lipid modification
start at high dose for all patients who have had a cardiovascular event
for primary prevention, consider starting with a high intensity statin if the patient is at high or very high rirsk
eg. atorvastatin, rosuvastatin, simvastatin
indications of statin-associated muscle symptoms
bilateral pain
aching or stiffness
pain located in the large muscle groups
onset 4 to 6 weeks after starting statin
high dose statin
elevated CK concentration that decreases with statin withdrawal
serum CK concentration
statin therapy can be contnued in a patient without symptoms provided serum CK concentraton does not exceed 5 times the upper limit of normal
if the patient has suspected statin-associated muscle symptoms
stop for 2-4 weeks, or 2-8 weeks if serum CK is more than 5 times the upper limit
restart same statin at. lower dose or try a dfferent statiin
statin-induced rhabdomyolysis
rare but life threatening adverse effect of statins
the serum CK concentration is typically 10 tmes the ULN
perform urinalysis to detect myoglobinuria
do not restart statin therapy in patients with confirmed rhabdomyolysis
familial hypercholesterolaemia
dominantly inherited condition
accelerates atherosclerotic cardiovascular diseaase by 20-40 years
start lipid lowering therapy at the time of diagnosis
secondary dyslipidaemia
hypothyroidism
nephrotic syndrome
cholestasis
type 2 diabetes
obesity
excessive alcohol consumption
chronic kidney disease
some drugs
