Lipid update

Question 1

Is there any advantage in giving thiazide diuretic to someone with a beta blockers with a BP of 140/80?

Answer 1

Yes - add thiazide diuretic intensively to reduce to 120/80

Question 2

Intensive management of blood pressure

Answer 2

Intensive lifestyle modification
Aspirin
High dose statin
Optimal blood pressure

Question 3

Example of statin and its dose

Answer 3

Atorvastatin 40-80mg od

Question 4

What do you call it when patients are given a statin and told they might get muscle pain and they do actually get muscle pain?

Answer 4

nocibec event

Question 5

What is PCSK9?

Answer 5

It controls the rate of LDL receptor

Question 6

What is PCSK9?

Answer 6

It controls the rate of LDL receptor by breaking it down

Question 7

Give an example of a PCSK9 inhibitor? What does it do?

Answer 7

Evolocumab - stops the breakdown of LDL receptor

Question 8

How effective was adding PCSK9 in lowering LDL levels?

Answer 8

Reduces MI chance, but doesn’t reduce the chance of death

Question 9

Compare adding PCSK9 to statin with adding thiazide to BB

Answer 9

PCSK9 was marketed for those with statin intolerance

Problem is that it is SO EXPENSIVE compared to thiazide

Question 10

How long does it take to have good blood glucose control?

Answer 10

15 years

Question 11

What is the legacy effect?

Answer 11

If you have tight control when you have patent coronary arteries, the benefits persist even if you then become less well control. Basically good control early on in your disease is excellent. The benefits exist for at least 30 years.

Question 12

UKPDS study - intensive T2DM therapy findings

Answer 12

20 years intervention

Further 10 ears follow-up showed that the study group benefited even after the study was over

Question 13

What happened when Rosiglitazone was given to patients? What was the study called and who was it done by and done on?

Answer 13

Tight blood glucose control in later stages of life caused more death. It has been banned.

Thiazolidinedione

ACCORD study done by pharma companies - they took patietns who had already had 1 vascular event.

After this,

Question 14

The first trial

Answer 14

DCCT - diabetes control and complications trial

Good control improves everything

Question 15

How does SGLT 2 inhibitors work

Answer 15

GLYCOSURIC DRUG

They make you pee our glucose as they stop glucose reabsorption in the PCT

You loose BP as it is a diuretic
and you loose weight because you’re losing

Question 16

What does MACE mean?

Answer 16

Major adverse cardiac events

Question 17

Name an SGLT2 inhib and its effectiveness

Answer 17

Empaglifozin - the cardiovascular death risk reduces within six months!

Question 18

What was the study on SGLT2 inhibitors called?

Answer 18

EMPA-REG study

Question 19

What is the one side effect of SGLT2 inhibitors?

Answer 19

More likely to get UTI

Question 20

Empaglifozin effects on kidneys

Answer 20

Risk of nephropathy, need for dialysis and doubling serum-creatine dropped

Question 21

What do you see in terms of effects of empaglifozin?

Answer 21

Initially it makes your eGFR worse but as you persist, it has a renoprotective effect (like with ACE-inhibitors)

Question 22

Overall, what is the effect of empaglifozin?

Answer 22

Reduces blood sugars
Reduces CV risk
Reduces renal risk

Question 23

Name a GLP-1 analogue

Answer 23

Liraglutide

Question 24

What’s the problem with GLP-1 analogues?

Answer 24

they are a peptide so need to be taken

Question 25

Key diabetes drugs

Answer 25

Metformins
SGLT2
GLP-1 receptor agonist