Lipids

Question 1

T/F most people can lower high cholesterol if they lose weight, eat better, and exercise more

Answer 1

TRUE! - ABCDE, aspirin (not prescribed anymore)c, BP 130/80, Cholesterol, Cigarettes, Diet, Diabetes, Exercise are all primary prevention changes

Question 2

What is the first line treatment to decrease cholesterol and reduce risk of ASCVD events?

Answer 2

statins

Question 3

What should be considered for a patient has issues with taking statin medication or statin therapy alone is not effective?

Answer 3

nonstatin drug in combination or as monotherapy

Question 4

What patient risk groups are high and very high risk for ASCVD?

Answer 4

DM patient with multiple risk factors for ASCVD

LDL > 190

Question 5

What should be considered for a patient that has issues with taking statin medication or statin therapy alone is not effective?

Answer 5

nonstatin drug in combination or as monotherapy

Question 6

A patient on high-intensity statin therapy with LDL-C >100, what medication should be added?

Answer 6

ezetimibe

severe primary hypercholesterolemia (>190) on high statin therapy and LDL remains >100 needs

Question 7

What statins are high intensity? (2)

Answer 7

Atorvastatin 40-80

Rosuvastatin 20-40

Question 8

What statins are moderate intensity? (7 meds Pi,RAS,PLF)

Answer 8

Pitavastatin 1-2
Rosuvastatin 5-10
Atorvastatin 10-20
Simvastatin 20-40
Pravastatin 40-80
Lovastatin 40-80
Fluvastatin 80

Question 9

What is the goal of high-intensity statin therapy? (LDL reduction %)

Answer 9

reduction by 50% in LDL-C

Question 10

What risk factors (8) are associated in the calculation of ASCVD?

Answer 10

smoking (current)
HTN or BP >130/80
abnormal cholesterol
DM
age (>55 years male >65 female)
Family hx 
obesity
inactive lifestyle

Question 11

What is the % goal of high-intensity statin therapy? (LDL reduction %)

Answer 11

reduction by 50% in LDL-C

Question 12

What is the % goal of moderate-intensity statin therapy? (LDL reduction %)

Answer 12

30-49% reduction in LDL-C

Question 13

What is the % goal of low-intensity statin thearpy? (LDL reduction %)

Answer 13

<30% reduction in LDL-C

Question 14

What statin medications (4) are considered low-intensity therapy?

Answer 14

Simvastatin 10
Pravastatin 10-20
Lovastatin 20
Fluvastatin 20-40

Question 15

A nonstatin, ezetimibe, will reduce LDL-C by ____%

Answer 15

20 %

decreases cholesterol absorption

Question 16

A nonstatin, PCSK9 inhibitor, will reduce LDL-C by __-___%

Answer 16

50-60 %

prolongs LDL receptor activity

Question 17

A 20-75 year old with LDL >190 requires ____-intensity statin therapy

Answer 17

high

hypercholesterolemia

Question 18

If a patients LDL remains >100 on statin therapy (high dose if tolerated), what should the PCP consider as the next treatment? Second choice if >100 on dual therapy?

Answer 18

> 100 LDL on statin = add Ezetimibe

> 100 LDL on statin & Ezetimibe = add PCSK9 Inhibitor

Question 19

A diabetic patient without additional risk factors for ASCVD, requires what form of primary prevention?

Answer 19

primary prevention with a MODERATE-intensity statin

goal is to reduce LDL by 30%, this is achieved with moderate-intensity statin

Question 20

A diabetic patient WITH risk factors (1 or more/>20%) for ASCVD, requires what form of primary prevention?

Answer 20

primary prevention with a HIGH-intensity statin

goal is to reduce LDL by 50%, this is achieved with high-intensity statin

Question 21

A 40-75 year old patient without DM, LDL 70-189 and ASCVD >7.5% should have ___-intensity therapy.
If the patient refuses statin therapy, what should the PCP consider?

Answer 21

start moderate-intensity statin

uncertain/discussion does NOT favor statin therapy = Coronary Artery Calcium

Question 22

What is considered high risk ASCVD (10-year risk calculator %)

Answer 22

> / 20% = HIGH-intensity statin therapy

Question 23

What 3 factors are considered for patients with a CAC of 0 and ASCVD >7.5%

Answer 23

smoker
Diabetes mellitus
family hx of premature ASCVD

may delay therapy if CAC is 0 and no additional RF are present with ASCVD >7.5%