management of dyslipidemia ๐ชค Flashcards
How to diagnose Dyslipidaemia? & Targets
- Total cholesterol (TC) > 5.2 mmol/L
- High density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L (males); < 1.2 mmol/L (females)
- Triglycerides (TG) > 1.7 mmol/L
- Low density lipoprotein cholesterol (LDL-C) levels - will depend on the patientโs CV risk
Framingham General (FRS) CVD Risk Score โ 10 years risk of CVD
- age
- hdl
- tc
- sbp w/o tx
- sbp
-smoker - dm
What is the management for dyslipidaemia?
Therapeutic lifestyle changes (TLC)
-
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
-
regular exercise
- at least 150 minutes a week of moderate intensity or
- 75 minutes a week of vigorous intensity PA or an equivalent combination
-
avoidance of tobacco smoking
- increases serum levels of HDL-C
- alcohol restriction
- 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
Advising life style modifications in most diseases
SNAP
Smoking
Nutrition โ what kind of diet for the specific disease? DASH for hpt
Alcohol
Physical activity
Why are statins taken at night?
cholesterol is biosynthesized in the early mroning hours so statins w short half lives should be taken at night
can statins be taken during pregnancy
no it is c/i in pregnancy and lactation. shouldnt be given in child bearing age
mechanism of action of statins?
HMG CoA reductase inhibtor- inhibits hepatic cholesterol production
low dose statin therapy?
simvastatin 10mg
moderate dose statin therapy
simvastatin 20-40mg
high dose statin therapy?
atorvastatin 40-80mg
rosuvastatin 20-40mg
What are the recommendations for secondary preventions in โ coronary heart disease & โก stroke?
โ CHD
- 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
- ACS
- early initiation/continuation of high dose statin
- Aim target < 1.8 mmol/L or 50% reduction in baseline (whichever lower)
- 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
โก Stroke
in ALL pt with previous non cardioembolic ischaemic stroke / TIA