Lipids Flashcards
At what age should you start testing lipids in individuals with no past medical history
20
what are the high intensity statins
rosuvastatin 20 and 40 mg
atorvastatin 40 and 80 mg
by what percentage should high intensity statins lower LDL-C cholesterol
> /=50%
what intensity statin should be used for patients aged <75 with clinical ASCVD
high intensity, or as high as can be tolerated to reduce >/= 50%
what intensity statin should be used for patients aged <75 with clinical ASCVD but cannot tolerate high intensity statin
moderate intensity statin with aim to reduce LDL to 30-49%
what medications should be on board or at least trialed at max tolerated doses prior to starting PCSK9
statin
ezetimibe
what intensity statin should you start for patients aged 20-75 that have an LDL-C of >/= 190 mg/dL
high intensity
or as high as tolerated
when do you start statin for patients with DM?
age 40-75
regardless of ASCVD risk start at least a moderate intensity statin immediately
LOE: IIb
if age 20-39 and have DM, do you start statin
yes it is reasonable if: long standing >10 yrs DM2, >20 years DM1 albuminuria eGFR <60 retinopathy neuropathy ABI <0.9
what to do if ASCVD risk is <5%
emphasize lifestyle modifications to reduce risk factors
what to do if ASCVD risk of >7.5-20%
this is intermediate risk
start MODERATE intensity statin
reduce LDL-C by 30-49%
what to do if ASCVD risk >/=20%
this is high risk
start HIGH intensity statin
reduce LDL-C by >/=50%
if decision to start statin is uncertain, what other tool can the cardiologist use to help support this decision
calcium scoring
zero - low risk
1 to 99 - favors statin esp if >age 55
100+ and/or 75th percentile - start a statin, honey
how often do you check lipid profiles
1-3 months after starting statin
3-12 months thereafter to assess adherence or safety
in children and adolescents with lipid disorders related to obesity - what do you recommend
intensity lifestyle therapy
caloric restriction
regular aerobic physical activity
LOE IIa (BR) in kids 10+ years old, LDL is persistently >190+ and it seems they have familial hypercholesterolemia what do you do
try 3-6 months of lifestyle therapy
if do not respond, start statin
which race/ethnicity is at high risk of ASCVD
SOUTH Asians!
which race/ethnicity has increased sensitivity to statins
EAST Asians!
which race/ethnicity has an increased prevalence of HTN
Black population
age >20 with moderate hyperTG 175-499 what do you do
treat lifestyle factors (obesity, metabolic syndrome)
secondary factors (DM, liver or kidney dz, thyroid)
and medications that increase TG
elevated TG, what are the proposed differences between those with moderate vs severe hyperTG
(150-499 vs 500+)
moderate TG: excess TG carried in VLDL
severe TG: excess TG carried in VLDL + have excess chylomicrons
severe hypertriglyceridemia can potentially cause what kind of disease
pancreatitis
TG>500 but ESPECIALLY if >1000 mg/dL
women of child bearing age who are on statin therapy AND sexually active, should be counseled to do what?
use reliable form of contraception!
women of child bearing age who plan to become pregnant should stop the statin when?
stop 1-2 months before pregnancy is ATTEMPTED
women of child bearing age who become pregnant while on a statin should do what?
stop the statin as soon as the pregnancy is discovered
fact or fiction:
both cholesterol and TG INCREASE with pregnancy
true story
should we start statins in patients with ESRD on HD
no, LOE III (no benefit)
in patients with ESRD on HD who already are on a statin can you continue?
ok to continue (LOE IIb)
patient starts a statin and develops new onset DM, what do you do
continue statin
when do you measure CK levels in patients on statins
when there is suspected statin associated muscle symptoms or objective muscle weakness
when do you measure LFTS in patients on statins
if there are symptoms suggesting hepatotoxicity
patients with non-severe statin induced side effects, what do you do
can reduce dosage
use alternate statin
combine with nonstatin therapy
fact or fiction:
CoQ10 is recommended for patients with statin associated myalgias
fiction it is class III: no benefit
should be do routine measurements of LFT and CK in patients placed on statins
no
what is the mechanism proposed for statin associated myalgias?
depletion of coQ10
this doesn’t mean you should supplement routinely
what is the order of starting the below:
ezetimibe, PCSK9, statin
statin first
ezetimibe
last PCSK9
must consider the cost/benefit of starting PCSK9
