MT2_3_Dyslipidemia_Guidelines

Question 1

AACE ASCVD Extreme Risk

GOAL

Answer 1

• progressive ASCVD
• Unstable angina, despite LDL being less than 70
• established cardio disease in patients with DM, CKD, HeFH
• Premature ASCVD (men less than 55, women less than 65)
• LDL less than 55
• nonHDL less than 80
• ApoB less than 70

Question 2

AACE ASCVD Very High Risk

GOAL

Answer 2

• recent hospitalization for ACS, coronary, carried, vascular disease, 10 year risk greater than 20%
• DM or CKD 3/4 with more than 1 risk factor
  HeFH
• LDL less than 70
• nonHDL less than 100
• ApoB less than 80

Question 3

AACE High Risk

GOAL

Answer 3

• more than 2 risk factors and 10 yr risk 10-20%
• DM or CKD 3/4 with no other risk factors
• LDL less than 100
• nonHDL less than 130
• ApoB less than 90

Question 4

AACE Moderate Risk

GOAL

Answer 4

• less than 2 risk factors and less than 10%
• LDL less than 100
• nonHDL less than 130
• ApoB less than 90

Question 5

What are the major risk factors?

Answer 5

• High LDL (greater than 160), TC (grater than 240),Non HDL (greater than 200), Low HDL (less than 50W, 40M)
• PCOS
• HTN
• Family History
• CKD 3 or 4
• evidence of coronary artery calcification
• age (men over 45, women over 55)
• Low HDL (less than 40)
• smoking

Question 6

When should young adults be screened? Middle aged? Older Adults?

Answer 6

Young adults every 5 years, q3-5 if fam hx or diabetic

Middle aged (greater Ethan 45, 55) q1-2 years

Older: annually

Question 7

Define clinical ASCVD

Answer 7

• cardiovascular problems (acute coronary syndrome, hx of MI, stable/unstable angina, coronary revascularization)
• cerebrovascular complications (stroke, ischemic attack)
• peripheral artery disease

Question 8

Considerations with Ezetimibe?

Answer 8

<25% LDL-C lowering required
• Recent ACS <3 mo
• Cost considerations and future cost savings
• Ease of oral administration with low pill burden
• Heart failure*
• Hypertension*
• Age >75 yrs*
• Diabetes*
• Stroke*
• CABG*
• PAD*
• eGFR <60 mL/min/1.73 m2*
• Smoking*

Question 9

Considerations with PCSK9 inhibitors?

Answer 9

• > 25% LDL-C lowering required
• Cost
• Administration of SC injection
• Every 14-day or monthly dosing schedule
• Storage requirements (refrigeration)

Question 10

What is the threshold for LDL levels?

Answer 10

less than 40mg/dl

Question 11

If a patient has hypertriglyceridemia, what is the recommendation?

Answer 11

• TLC for patients with TG >150
• initiate meds if TG is greater than 500 (fibrates, omega 3)

overall fibrates are more preferred when TG greater than 200, HDL less than 40, but still use with caution with a concurrent statin

*BARs may increase hypertriglyceridemia

Question 12

Lipid Panel Monitoring in ACC/AHA vs AACE?

Answer 12

• ACC/AHA: q 4-12 weeks after initiation
• then every 3-12 months when stable

For AACE, it is every 6 weeks then every 6-12 months

Question 13

For familial hypercholesterolemia, what are the thresholds? Goal?

Answer 13

• less than 20 years, LDL greater than 160 and nonHDL less than 190
• greater than 20 years, LDL greater than 190 and nonHDL grater than 220
• goal is a reduction of LDL greater than 50%

Question 14

Which statins are CI in pregnancy?

Answer 14

• statins, niacin, ezetimibe

- recommend fibrates, or colesevelam

Question 15

for kids, when should pharmacologic therapy be initiated?

Answer 15

• LDL greater than 190
• LDL greater than 160 and more than 2 ASCVD risk factors
• FamHx
• Overweight, DM

Question 16

Which meds should be given to kids?

Answer 16

• ALS, pravastatin, rosuvastatin

- BARs cholestyramine

Question 17

What is considered acceptable, borderline, and high LDL levels for kids?

Answer 17

• Acceptable: less than 100
• Borderline: 100-129
• High: greater than 130