Lipid Update Flashcards
What does the SPRINT study suggest?
The use of thiazides on top of everything else for secondary prevention in patients with Coronary Heart disease, prior MI and borderline BP of 140/100
What is the optimal medical therapy in people with coronary heart disease?
Intensive lifestyle modification Aspirin High dose statin Optimal BP control Thiazide
What kind of management of BP and lipids is best to improve survival
AGGRESSIVE management
What is a good drug option for people with statin intolerance?
Evolocumab
Explain MOA of Evolucomab
it is a PCSK9 monoclonal antibody
PCSK9 is a protein that degrades LDL receptor (LDL R degrades LDL)
By blocking PCSK9, LDL R can keep degrading LDL
SO no heart disease occurs
What did the study on Evoloclumab establish?
It decreased CV events
Significantly reduced LDL
NO major effect on mortality
Who is Evoloclumab useful IN?
Patients with very high uncontrolled LDL e.g. familial hypercholesteraemia
What is a downside to Evoloclumab use?
It is a VERY EXPENSIVE drug
What did the UKPDS study show?
That aggressive blood glucose control maintains low HbA1c over 14 years follow up
And improved outcomes for everything
How long does it take for benefits to become apparent on the UKPDS?
15 years
What happened to UKPDS who after the study reverted to poor blood glucose control?
They quickly reached similar HbA1c to their counterparts
Explain the legacy effect in the UKPDS trial
Patients in the intensive treatment group had low mortality despite their blood glucose deteriorating the same as controls
This means that GOOD BLOOD GLUCOSe even for short time periods has beneficial effect
What did the ACCORD study show
ACCORD: they tried to very aggressively control glucose (aimed for HbA1C of 6.0) in people who had decades of poor control
They found that this had massive increased mortality
What did the ADVANCE study show?
That less aggressive control (aim HbA1c of 6.5) reduced death
What did the DCCT study show?
In T1DM, good control improves outcomes