Lipids

Question 1

At what age should you start testing lipids in individuals with no past medical history

Answer 1

20

Question 2

what are the high intensity statins

Answer 2

rosuvastatin 20 and 40 mg

atorvastatin 40 and 80 mg

Question 3

by what percentage should high intensity statins lower LDL-C cholesterol

Answer 3

> /=50%

Question 4

what intensity statin should be used for patients aged <75 with clinical ASCVD

Answer 4

high intensity, or as high as can be tolerated to reduce >/= 50%

Question 5

what intensity statin should be used for patients aged <75 with clinical ASCVD but cannot tolerate high intensity statin

Answer 5

moderate intensity statin with aim to reduce LDL to 30-49%

Question 6

what medications should be on board or at least trialed at max tolerated doses prior to starting PCSK9

Answer 6

statin

ezetimibe

Question 7

what intensity statin should you start for patients aged 20-75 that have an LDL-C of >/= 190 mg/dL

Answer 7

high intensity

or as high as tolerated

Question 8

when do you start statin for patients with DM?

Answer 8

age 40-75

regardless of ASCVD risk start at least a moderate intensity statin immediately

Question 9

LOE: IIb

if age 20-39 and have DM, do you start statin

Answer 9

yes it is reasonable if:
long standing >10 yrs  DM2, >20 years DM1
albuminuria
eGFR <60 
retinopathy
neuropathy
ABI <0.9

Question 10

what to do if ASCVD risk is <5%

Answer 10

emphasize lifestyle modifications to reduce risk factors

Question 11

what to do if ASCVD risk of >7.5-20%

Answer 11

this is intermediate risk
start MODERATE intensity statin
reduce LDL-C by 30-49%

Question 12

what to do if ASCVD risk >/=20%

Answer 12

this is high risk
start HIGH intensity statin
reduce LDL-C by >/=50%

Question 13

if decision to start statin is uncertain, what other tool can the cardiologist use to help support this decision

Answer 13

calcium scoring
zero - low risk
1 to 99 - favors statin esp if >age 55
100+ and/or 75th percentile - start a statin, honey

Question 14

how often do you check lipid profiles

Answer 14

1-3 months after starting statin

3-12 months thereafter to assess adherence or safety

Question 15

in children and adolescents with lipid disorders related to obesity - what do you recommend

Answer 15

intensity lifestyle therapy
caloric restriction
regular aerobic physical activity

Question 16

LOE IIa (BR) 
in kids 10+ years old, LDL is persistently >190+ and it seems they have familial hypercholesterolemia what do you do

Answer 16

try 3-6 months of lifestyle therapy

if do not respond, start statin

Question 17

which race/ethnicity is at high risk of ASCVD

Answer 17

SOUTH Asians!

Question 18

which race/ethnicity has increased sensitivity to statins

Answer 18

EAST Asians!

Question 19

which race/ethnicity has an increased prevalence of HTN

Answer 19

Black population

Question 20

age >20 with moderate hyperTG 175-499 what do you do

Answer 20

treat lifestyle factors (obesity, metabolic syndrome)
secondary factors (DM, liver or kidney dz, thyroid)
and medications that increase TG

Question 21

elevated TG, what are the proposed differences between those with moderate vs severe hyperTG
(150-499 vs 500+)

Answer 21

moderate TG: excess TG carried in VLDL

severe TG: excess TG carried in VLDL + have excess chylomicrons

Question 22

severe hypertriglyceridemia can potentially cause what kind of disease

Answer 22

pancreatitis

TG>500 but ESPECIALLY if >1000 mg/dL

Question 23

women of child bearing age who are on statin therapy AND sexually active, should be counseled to do what?

Answer 23

use reliable form of contraception!

Question 24

women of child bearing age who plan to become pregnant should stop the statin when?

Answer 24

stop 1-2 months before pregnancy is ATTEMPTED

Question 25

women of child bearing age who become pregnant while on a statin should do what?

Answer 25

stop the statin as soon as the pregnancy is discovered

Question 26

fact or fiction:

both cholesterol and TG INCREASE with pregnancy

Answer 26

true story

Question 27

should we start statins in patients with ESRD on HD

Answer 27

no, LOE III (no benefit)

Question 28

in patients with ESRD on HD who already are on a statin can you continue?

Answer 28

ok to continue (LOE IIb)

Question 29

patient starts a statin and develops new onset DM, what do you do

Answer 29

continue statin

Question 30

when do you measure CK levels in patients on statins

Answer 30

when there is suspected statin associated muscle symptoms or objective muscle weakness

Question 31

when do you measure LFTS in patients on statins

Answer 31

if there are symptoms suggesting hepatotoxicity

Question 32

patients with non-severe statin induced side effects, what do you do

Answer 32

can reduce dosage
use alternate statin
combine with nonstatin therapy

Question 33

fact or fiction:

CoQ10 is recommended for patients with statin associated myalgias

Answer 33

fiction
it is class III: no benefit

Question 34

should be do routine measurements of LFT and CK in patients placed on statins

Answer 34

no

Question 35

what is the mechanism proposed for statin associated myalgias?

Answer 35

depletion of coQ10

this doesn’t mean you should supplement routinely

Question 36

what is the order of starting the below:

ezetimibe, PCSK9, statin

Answer 36

statin first
ezetimibe
last PCSK9
must consider the cost/benefit of starting PCSK9