Lipids Flashcards
Who gets statins for secondary prevention of ASCVD?
1) Those with ASCVD
2) LDL > 190
3) DM
4) >7.5% of 10 year ASCVD risk
Intensity of statin therapy depends on what category you fall into
What are HMG co-A reductase inhibitors also known as?
Statins
Yo mamma’s so fat!
How fat is she??
That she qualifies for high intensity statin therapy!
ohhhhh!!!!!!!
Statin therapy for those with primary HLD
For patients with LDL > 190
Results in LDL reduction by 39 points
Reduces ASCVD risk by 20%
May need additional lipid lowering agent that isn’t a statin
Do you automatically qualify for statin therapy if you have DM?
Yes
Statin therapy for those with DM
Ok to give moderate intensity
For patients 40-75 y/o with DM (I or II)
Have significant benefit from statin therapy
Give high intensity if 10 year risk is >7.5%
Who should you do an 10 year ASCVD risk for?
For people without existing ASCVD, without DM, and LDL t obviously need statins
Statins will reduce ASCVD risk across ____ LDL levels
all
When to treat triglycerides?
If TG > 200 and LDL is already under control, then add another agent for TGs.
What about statins and HDL?
Treat with statins if HDL < 40
Remember that statins will decrease TG and LDL and increase HDL.
How do bile acid sequestrants work?
The bind bile acid in the intestines, forcing the liver to use cholesterol to produce more bile acids.
This can cause oily BMs. Fun!
Effect of a statin plus niacin
Risk of hepatic dysfunction
What are cholesterol and triglycerides needed for?
TG- essential energy source
Cholesterol- Cell membranes, bile acids, steroid hormones
S/S of HLD
Xanthelasma (fatty deposits in skin and eyes)
Circumferential arcus
PVD (shiny extremities, hairlessness, skin discoloration- redness)
Thickened achilles
HTN or DM (these ppl usually have HLD)
If you get a lipid panel and the person forgot to fast, you can still use these values
Total Cholesterol (TC) HDL
Even if they forgot to fast and their TC > 200 or HDL is <40, bitch-slep them, tell them to fast this time, and then retest.
What do we care about more? Your LDL level or overall ASCVD risk?
ASCVD risk
TC and TG levels in someone with Primary (familial) HLD
TC > 200
TG > 500
Secondary HLD can be caused by
DM CRF Hypothyroidism Obstructive liver disease Medications that increase LDL and decrease HDL (corticosteroids, progestins, and anabolic steroids-->all types of steroids!) Many other disease processes as well
Effect of alcohol on lipid panel
Increase in TG
Increase in HDL
What is the overall goal of the newest ACC/AHA guidelines?
Relative reduction of ASCVD risk by using statins
What should people get screened for every 4-6 years starting at age 20?
Lipid profile (TC, TG, LDL, HDL)
ALT CK, HbA1c, 10 year ASCVD assessment
Herpes
What is primary HLD prevention?
Lifestyle changes (reduced dietary saturated fats and cholesterol, exercise, and weight control) Recommended for all patients regardless of state of health
Dietary influences on HDL and LDL
HDL
- Elevated by alcohol, weight loss, and saturated fats
- Lowered by low fat diet, sugar, excess calories, and excess polyunsaturated fats
LDL
- Elevated by saturated fat, trans-fatty acids, and cholesterol
- Lowered by monounsaturated fatty acids, complex carbs (fiber!), and soy
Saturated fats elevate both kinds.
Four main categories established as candidates for statin therapy
Clinical ASCVD
10 year ASCVD risk > 7.5%
LDL > 190
DM
Intensity of the therapy depends on what category you fall into
Statin therapy will reduce ASCVD risk for anyone with an LDL level over
70
These are the two high-intensity statin meds
Atorvastatin 80mg
Rosuvastatin 20mg
How do statins work?
The inhibit HMG Co-A reductase, which is the rate limiting enzyme in the production of cholesterol.
Statins for people with ASCVD
If < 75, give high intensity
If > 75 or if high-intensity therapy is contraindicated, give moderate therapy.
A reduction of LDL by ____ will decrease the risk of ASCVD by _____
39 mg/dL
20%
Statin therapy for those with DM
If age 40-75 and LDL 7.5%, then give high-intensity.
Does the data support statin use as a primary therapy?
Yes.
How can you identify a bile acid sequestrant?
The names begin with chole/cole –> Referring to bile!
How does nicotinic acid (Niacin) work?
By reducing the production of VLDLs
Form of nicotinic acid (niacin) that is sustained release
Niaspan
How do fibric acid derivatives work?
They reduce the synthesis of and increase the destruction of VLDLs
How can you identify a fibric acid derivative?
“Fibr” will be hidden in the name somewhere.
The most common one is Gemfibrozil (Lopid)
How does Ezetimibe (Zetia) work?
Preventing the absorption of cholesterol and phytosterol at the brush border of the intestines. Despite this, it has no effect on the absorption of fat soluble vitamins.
Ezetimibe (Zeta) is supposed to be prescribed with
A statin.
This is a potential SE of any statin
Myopathies. People especially at risk include age >80, small body frame/frail people, impaired hepatorenal function, ETOH abuse)
Things to know about Statin/Fibric Acid Derivative combo therapy
Primarily assists in decreasing TGs
Increased risk of myopathies
Contraindicated in severe hepatic disease
What is the only lipid lowering agent you can take during pregnancy?
Bile-acid sequestrants. Yay pregnancy! Yay oily poops!
