pre-reading Flashcards
LDL cholesterol levels
LDL Cholesterol
desire- <100 mg/dL boderline- 130-189 mg/dL very high- >190 mg/dL
HDL cholesterol levels
HDL Cholesterol
Men: >40 mg/dL
Women: >50 mg/dL
triglycerides levels
Triglycerides
desire- <150 mg/dL
boderline- 150-499 mg/dL very high- >500 mg/dL
total cholesterol calculation
Total cholesterol calculation = (TG/5)+HDL+LDL
%LDL reducation
% LDL reduction = (current LDL level-LDL goal)/current LDL level
Non pharm
weight reduction
• Weight reduction if BMI ≥ 25 kg/m2
non-pharm
• Diet
o Vegetables, fruits, whole grains, legumes, nuts
o Consume fish, oily fish at least twice per week
o At least 50% of grain intake should be whole grains (modest LDL reduction, satiety)
o Limit intake of saturated fat to <7% of total, trans fat <1% of total, cholesterol <300 mg/day
Choose lean meat (limit red meat) and vegetable alternatives
Select fat-free, 1% fat and low fat dairy products
Minimize partially hydrogenated fats
non-pharm
Exercise
• Exercise: 40 minutes of aerobic activity 3-4 days per week , moderate-vigorous intensity
non-pharm
Alcohol
• Alcohol: men ≤ 2 drinks, women ≤ 1 drink per day
o Increases HDL and TRG
non-pharm
tobacco and sugar
• Tobacco Cessation
• Limit/Eliminate added sugars including those from beverages
o Added sources of sucrose and fructose can significantly impact triglyceride
High intensity statins
atorvastatin (40mg-80mg)
rosuvastatin 20-40 mg
moderate intensity stating
atorvastating 10-20mg
tsuvastating 5-10mg
simvastatin 20-40mg
pravastatin 40-80mg
lovastatin 40-80mg
fluvastatin 40mg BID
pitvastatin 1-4 mg
low intensity
simvastatin 10mg
pravastatin 10-20 mg
lovastatin 20 mg
fluvastatin 20-40 mg
ASCVD
Clinical ASCVD consists of ACS, those with history of MI, stable or unstable angina or coronary other arterial revascularization, stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD) including aortic aneurysm, all of atherosclerotic origin
recommend for adults with CKD
o In adults 40 to 75 years of age with LDL-C 70 to 189 mg/dL who are at 10-year ASCVD risk of 7.5% or higher, CKD not treated with dialysis or kidney transplantation is a risk-enhancing factor and initiation of a moderate-intensity statin or moderate-intensity statins combined with ezetimibe can be useful.
o In adults with advanced kidney disease that requires dialysis treatment who are currently on LDL-lowering therapy with a statin, it may be reasonable to continue the statin.
o In adults with advanced kidney disease who require dialysis treatment, initiation of a statin is not recommended
• Diabetes-Specific Risk Enhancers That Are Independent of Other Risk Factors in Diabetes
- long duration >=10 years of type 2 diabetes or >= 20 years for type 1 diabetes
- albuminuria >= mcg albumin/mg creatinine
- eGFR<60 ml/min/1.73msq
- retinopathy
- neuropathy
- ABI<0.9
treatment pearls
statin intolerance
• Primary reason for not being a statin candidate is intolerance (myalgias).
o Consider alternative dosing (tiw, weekly)
o Switch to a different statin
o Check vitamin D level and replace as necessary
o Consider coenzyme q 10 trial (100-200 mg daily) for 2-4 weeks and restart statin.
LDL
• Ldl levels <40 mg/dl are controversial. If very high risk, consider continuing treatment if tolerating.
goals of treatment
Prevent lipid complications
In very high rsk ASCVD LDL goal is ≤ 70 mg/dL
Familial: LDL <100 mg/dl and non-HDL <130 mg/dl. If unable to achieve, >50% reduction in both levels
If triglycerides >500 mg/dl (1000 mg/dl), becomes primary goal until <500 mg/dl.
monitoring
- Adverse effects of lipids
- Symptoms: HA, chest pain, SOB, nausea
- Assess adherence and percentage response to LDL-C–lowering medications and lifestyle changes with repeat lipid measurement 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.
niacin Adverse effect (minimized by)
Flushing (can be minimized by taking ASA or ibuprofen 1 hour prior)
N/V
Hepatotoxicity
Rhabdomyolysis
Ezetimibe
adverse effect
Diarrhea
Increased AST/ALT
No dosage adjustment is necessary with renal or mild hepatic insufficiency
Statins: ADE,
Hepatic dysfunction – increased liver enzymes Arthralgia and myalgia UTI Diarrhea Nasopharyngitis Extreme pain Rhabdomyolysis Tendon rupture New onset of diabetes (risk factors: BMI ≥30, fasting BG≥100 mg/dL; metabolic syndrome, or A1c ≥6%)
Statins: Monitoring,
Baseline serum creatine kinase, aminotransferase levels, AST/ALT,
Lipid panel annually if indicated, 3 months after starting
In patients with decreased RF monitor serum creatine kinase more closely
