Lipids Flashcards
T/F most people can lower high cholesterol if they lose weight, eat better, and exercise more
TRUE! - ABCDE, aspirin (not prescribed anymore)c, BP 130/80, Cholesterol, Cigarettes, Diet, Diabetes, Exercise are all primary prevention changes
What is the first line treatment to decrease cholesterol and reduce risk of ASCVD events?
statins
What should be considered for a patient has issues with taking statin medication or statin therapy alone is not effective?
nonstatin drug in combination or as monotherapy
What patient risk groups are high and very high risk for ASCVD?
DM patient with multiple risk factors for ASCVD
LDL > 190
What should be considered for a patient that has issues with taking statin medication or statin therapy alone is not effective?
nonstatin drug in combination or as monotherapy
A patient on high-intensity statin therapy with LDL-C >100, what medication should be added?
ezetimibe
severe primary hypercholesterolemia (>190) on high statin therapy and LDL remains >100 needs
What statins are high intensity? (2)
Atorvastatin 40-80
Rosuvastatin 20-40
What statins are moderate intensity? (7 meds Pi,RAS,PLF)
Pitavastatin 1-2 Rosuvastatin 5-10 Atorvastatin 10-20 Simvastatin 20-40 Pravastatin 40-80 Lovastatin 40-80 Fluvastatin 80
What is the goal of high-intensity statin therapy? (LDL reduction %)
reduction by 50% in LDL-C
What risk factors (8) are associated in the calculation of ASCVD?
smoking (current) HTN or BP >130/80 abnormal cholesterol DM age (>55 years male >65 female) Family hx obesity inactive lifestyle
What is the % goal of high-intensity statin therapy? (LDL reduction %)
reduction by 50% in LDL-C
What is the % goal of moderate-intensity statin therapy? (LDL reduction %)
30-49% reduction in LDL-C
What is the % goal of low-intensity statin thearpy? (LDL reduction %)
<30% reduction in LDL-C
What statin medications (4) are considered low-intensity therapy?
Simvastatin 10
Pravastatin 10-20
Lovastatin 20
Fluvastatin 20-40
A nonstatin, ezetimibe, will reduce LDL-C by ____%
20 %
decreases cholesterol absorption
A nonstatin, PCSK9 inhibitor, will reduce LDL-C by __-___%
50-60 %
prolongs LDL receptor activity
A 20-75 year old with LDL >190 requires ____-intensity statin therapy
high
hypercholesterolemia
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?
> 100 LDL on statin = add Ezetimibe
> 100 LDL on statin & Ezetimibe = add PCSK9 Inhibitor
A diabetic patient without additional risk factors for ASCVD, requires what form of primary prevention?
primary prevention with a MODERATE-intensity statin
goal is to reduce LDL by 30%, this is achieved with moderate-intensity statin
A diabetic patient WITH risk factors (1 or more/>20%) for ASCVD, requires what form of primary prevention?
primary prevention with a HIGH-intensity statin
goal is to reduce LDL by 50%, this is achieved with high-intensity statin
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?
start moderate-intensity statin
uncertain/discussion does NOT favor statin therapy = Coronary Artery Calcium
What is considered high risk ASCVD (10-year risk calculator %)
> / 20% = HIGH-intensity statin therapy
What 3 factors are considered for patients with a CAC of 0 and ASCVD >7.5%
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%