Treatment of Dyslipidemia Flashcards
Steps to evaluating dyslipidemia
- Fasting Lipid Profile
- Rule out secondary causes
- CHD Risk equivalents
- Major CHD Risk Factors
- Estimate 10 year risk with Framingham Score
- Establish treatment goals and therapy based on risk category
For what population is a lipid screening appropriate for?
All adults aged 20 or over, every 5 years
Secondary causes of Dyslipidemia
- Diabetes
- Hypothyroidism
- Obstructive liver disease
- Chronic renal failure
- Drugs that can increase LDL, decrease HDL (prostaglandins, thiazide diuretics, beta blockers, isotretinoin)
CHD Risk Equivalents
DM
peripheral arterial disease
abdominal aortic aneurysm
symptomatic carotid artery disease
multiple RF’s that confer a 10 year risk >20%
Major CHD RIsk Factors
- current smoker
- HTN >140/90 or on antihypertensive
- Low HDL <40
- FHx of premature CHD (55/65 MI or sudden death)
- Age and gender (45/55)
- Negative point: HDL >60
**If two or more risk factors are present, assess 10 year CHD risk
Therapeutic Lifestyle Changes
Healthy diet
Weight reduction
Increased physical activity
Metabolic syndrome
Three or more of:
Abdominal obesity
High TG
Low HDL
High BP
Insulin resistance
More common name of HMG Co A Reductase Inhibitors
statins
Statin mechanism of action
inhibit HMG CoA Reductase, thereby blocking endogenous cholesterol synthesis
stimulate hepatic LDL receptors, enhancing LDL clearance from plasma
Adverse effects of statins
Hepatic toxicity
Myopathy
Neuropathy
Reversible cognitive side effects
Contraindications of statins
pregnancy category X
active or chronic liver disease
Relative CI: niacin or gemfibrozil concomitant use
Statins have what kind of dosing curve do statins have?
Non linear–after a certain amount, little effect is had by doublin doses
Works best when dose at night
Bile Acid Resins (BAR)
Mechanism of action
Bind bile acids, forming an insoluble complex that is eliminated in the stool.
This promotes conversion of cholesterol to BAs in the liver.
May increase hepatic VLDL, increasing TGs
Adverse effects of Bile Acid Resins
GI symptoms–constipation, belching, flatulence, heart burn, abdominal distention nausea
CI of Bile Acid Resins
High TGs
H/O severe constipation
Decreases the absorption of other meds so stagger
Reasons to use BAR
Good in young pts with moderately high LDL, or in combination of statins for severe hyperlipidemia
Can be used with niacin and fibric acids
Fibric Acids mechanism of action
Increase lipoprotein lipase activity, enhacing VLDL and IDL catabolism, decreasing TGs
Promotes secretion of cholesterol in bile
Adverse effects of fibric acids
GI complaints
Increase bile lithogenicity
When to use fibric acids
Very good at lower TGs
Good for combined dyslipidemia
Avoid with statins (increase myositis)
Nicotinic Acid mechanism of action
Inhibits synthesis of VLDLs, lowering LDLs
Adverse effects of nicotinic acid
Flushing (MC)
May cause glucose intolerance and increase uric acid
Older forms cause hepatitis
CI of nicotinic acid
Liver disease
DM
gout
hyperuricemia
When to use nicotinic acid
Good for mixed hyperlipidemias
Start low, go slow, montitor for hepatic toxicity
Can take with aspirin to dec flushing
Cholesterol absorption inhibitors (ezetimibe) mechanism of action
Selectively inhibits the absorption of cholesterol
Adverse effects of cholesterol absorption inhibitors (ezetimibe)
fatigue,
abdominal pain
HA
diarrhea
arthralgia
When to use cholesterol absorption inhibitors (ezetimibe)
Can use in conjunction with statins if not reaching goal
Supplements for lowering cholesterol
Plant stanol esters: dec cholesterol absorption
Fish oils: esp if need lower TGs
Blond psyllium
Oat bran
