Lipids Flashcards
Cholesterol and fatty acids are absorbed from the GI tract as _____
chylomicrons
-chylomicrons are primarily triglycerides combined with cholesterol and apolipoproteins B-48 and A
Hepatic cells synthesize triglyceride rich ___ which is then released into circulation
VLDL
-turns into IDL then LDL (TG component of VLDL replaced with cholesterol)
Primary Goal
Reducing LDL, as it is the primary cause of atherosclerosis = stroke/MI/etc
Managing Cholesterol
-Heart healthy lifestyle
-Drug therapies
-ASCVD calculator
-After age 20, risk should be assessed every 4-6 years
-A lowering of LDL-C levels of 1% ~ 1% reduction
in the risk of ASCVD
Risk-enhancing factors to consider for Clinician-Patient Risk Discussion
-Family hx of premature ASCVD
-Hypercholesterolemia
-Metabolic syndrome
-CKD
-Inflammatory disease
-Hx of premature menopause/preeclampsia
-South Asian
-Elevated lipid biomarkers
FASTING REQUIRED
Triglycerides and LDL
9-12 hours of not eating or drinking
(total cholesterol and HDL - can be measured on fasting or non-fasting specimens)
Interpreting ASCVD risk
OTHER LABS TO MONITOR FOR PATIENTS ON STATIN THERAPY
-ALT/AST
-Total bilirubin, alk phos
-Creatine kinase activity
Retest LDL 4-6 weeks after initiating statin therapy
LDL GOALS FOR DRUG THERAPY
-High-intensity aims for 50% reduction in LDL concentration
-Moderate-intensity aims for 30-40% reduction in LDL concentration
-Low-intensity aims for LDL reduction of less than 30%
INDICATIONS FOR STATIN THERAPY
-LDL ≥ 160 = drug therapy
-LDL ≥ 190 = high-intensity statin
-Adults 40-75 with diabetes = statin
HYPERTRIGLYCERIDEMIA
-Moderate hypertriglyceridemia is fasting or nonfasting triglycerides of 175-499
-Severe hypertriglyceridemia is fasting triglycerides of > 500
-Patients with severe hypertriglyceridemia also have a risk for acute pancreatitis
-Patients treated with Omega-3 fatty acids and fibrates if necessary
Statins (rosuvastatin, atorvastatin, simvastatin, etc)
-MOA: competitive inhibition of HMG CoA reductase
-AE: myalgia, myopathy, increased transaminases
Ezetimibe
-MOA: cholesterol absorption inhibitor
-AE: increases in transaminases, myopathy
PCSK9 Inhibitors (Evolocumab, Alirocumab)
-MOA: degrades LDL receptor
Omega 3 FA
-MOA: reduces VLDL synthesis
-AE: diarrhea, NV, GI, fishy breath, bleeding
