management of dyslipidemia ๐Ÿชค Flashcards

1
Q

How to diagnose Dyslipidaemia? & Targets

A
  1. Total cholesterol (TC) > 5.2 mmol/L
  2. High density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L (males); < 1.2 mmol/L (females)
  3. Triglycerides (TG) > 1.7 mmol/L
  4. Low density lipoprotein cholesterol (LDL-C) levels - will depend on the patientโ€™s CV risk
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2
Q

Framingham General (FRS) CVD Risk Score โ€” 10 years risk of CVD

A
  • age
  • hdl
  • tc
  • sbp w/o tx
  • sbp
    -smoker
  • dm
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3
Q

What is the management for dyslipidaemia?

A

Therapeutic lifestyle changes (TLC)

  1. a healthy diet โ€” high in fibre, fruits and vegetable, wholegrain, low in salt and saturated/trans-fat
    • advised to refer to a dietician for medical nutrition therapy (MNT)
    • To optimize outcomes, motivational interviews are beneficial
  2. regular exercise
    • at least 150 minutes a week of moderate intensity or
    • 75 minutes a week of vigorous intensity PA or an equivalent combination
  3. avoidance of tobacco smoking
    • increases serum levels of HDL-C
  4. alcohol restriction
  5. maintenance of an ideal weight

Statin treatment has been clearly documented to reduce CV events in all age groups and irrespective of the baseline LDL-C

  • An achieved on-treatment LDL-C level of < 1.8 mmol/L appears to significantly slow down progression of atherosclerosis

> For Low and Intermediate (Moderate) risk โ†’ TLC ยฑ Statin

> For High and Very High CV risk โ†’ TLC + Statin

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4
Q

Advising life style modifications in most diseases

A

SNAP

Smoking
Nutrition โ€” what kind of diet for the specific disease? DASH for hpt
Alcohol
Physical activity

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5
Q

Why are statins taken at night?

A

cholesterol is biosynthesized in the early mroning hours so statins w short half lives should be taken at night

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6
Q

can statins be taken during pregnancy

A

no it is c/i in pregnancy and lactation. shouldnt be given in child bearing age

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7
Q

mechanism of action of statins?

A

HMG CoA reductase inhibtor- inhibits hepatic cholesterol production

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8
Q

low dose statin therapy?

A

simvastatin 10mg

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9
Q

moderate dose statin therapy

A

simvastatin 20-40mg

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10
Q

high dose statin therapy?

A

atorvastatin 40-80mg
rosuvastatin 20-40mg

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11
Q

What are the recommendations for secondary preventions in โ‘  coronary heart disease & โ‘ก stroke?

A

โ‘  CHD

  1. Stable CAD โ€” stable angina, asymptomatic MI and coronary atherosclerosis detected by coronary or CT Angiogram.
    • Statin therapy irrespective of LDL-C level
    • Aim target < 1.8 mmol/L or 50% reduction in baseline (whichever lower)
    • Optimal medical therapy โ€” antiplatelet (aspirin), statins, ฮฒ-blocker, ACE-i
  2. ACS
    • early initiation/continuation of high dose statin
    • Aim target < 1.8 mmol/L or 50% reduction in baseline (whichever lower)
  3. Post-PCI
    • pre-treatment statin 7 days prior to elective PCI reduce post-PCI MI
    • All pt post-revascularisation (CABG or PCI) should be on long term statin therapy, aim < 1.8mmol/L

โ‘ก Stroke

in ALL pt with previous non cardioembolic ischaemic stroke / TIA

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