Module 8/9 - Hyperlipidemia

Question 1

Normal HLD Levels
LDL
HDL
Total Cholesterol
Triglycerides
LDL/HDL
TC/HDL
ApoB

Answer 1

LDL < 130
HDL > 60
Total Cholesterol < 200
Triglycerides < 150
LDL/HDL Ratio < 3.0
TC/HDL Ratio < 3.5
Apo B < 80

Question 2

ASCVD Calculator Includes *

Answer 2

age, gender, race, BP, total cholesterol, HDL, LDL, DM, smoker, TX: HTN, ASA, STATIN

DOES NOT INCLUDE TRIGLYCERIDES

Question 3

4 Major Statin Benefit Groups

Answer 3

1. Clinical ASCVD
2. LDL >190 + w/o ASCVD
3. DM, 40-75yo, LDL 70-189, w/o ASCVD
4. w/o ASCVD OR DM, LDL 70-189, estimated 10yr ASCVD risk >7.5%

Question 4

ASCVD Risks Include *

Answer 4

Acute coronary syndrome, hx of MI, stable angina, coronary or arterial revascularization, stroke/TIA, PAD of atherosclerotic origin

Question 5

Who to treat for HLD *

Answer 5

table

Question 6

Risk Factors for Muscle Sx in Statin

Answer 6

• Multiple Dx (ie renal or hepatic)
• Polypharmacy
• Hx of musculoskeletal problems or elevated CK, family hx
• Grapefruit
• 75-80yo
• Asian Ancestry
• Female
• Low BMI or small frame
• Fraility
• Physical Activity
• Etoh or drug use

Question 7

What to do when Muscle Sx in Statin Appear *

Answer 7

• Hold statin for 2-4 weeks in event of intolerable sx, weakness, CK >3 time ULN
• Consider rhabdo in event of severe muscle pain, fatigue, generalized weakness, dark urine
  »> check CK, urine for myoglobin, SCr
  »> if rhabdo is confirmed, never restart statin
• look for other causes of sx
• check renal and hepatic function
• assuming no contraindication:
  »> challenge with same statin but lower dose once sx resolve. If sx return, discontinue statin. Once symptoms resolve, start a different statin at a lower dose, then increase as tolerate
  OR
  »> Start a low or target dose of a different statin once symptoms improve. Increase as tolerated. If not tolerated, try extending the dosing frequency, such as every other day or twice a wee
  OR
  »> For patients at low CV risk, consider lifestyle interventions in lieu of a statin

Question 8

High Intensity Statins *

Answer 8

Lowers LDL by >50%
- Atorvastatin 40-80
- Rosuvastatin 20-40

Question 9

Moderate Intensity Statins *

Answer 9

Lowers LDL by 30-49%
- Atorvastatin 10-20
- Fluvastatin 40 BID
- Fluvastatin XL 80
- Lovastatin 40-80
- Pitavastatin 1-4
- Pravastatin 40-80
- Rosuvastatin 5-10
- Simvastatin 20-40

Question 10

Low Intensity Statins *

Answer 10

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

Question 11

Vignettes at end of slide

Answer 11

listen for answers