Treatment of dyslipidemias

Question 1

what are the 4 major statin benefit groups identified in whom CVD risk reduction clearly outweights risk of adverse events?

Answer 1

1. secondary prevention - clinical ASCVD
2. primary prevention - LDL-C over 190 mg/dL
3. primary prevention - diabetics
4. primary prevention - without diabetes high risk

Question 2

what is the most common adverse effect of statins?

Answer 2

muscle complaints

Question 3

statin triggered autoimmune myophaty is associated with what antibody?

Answer 3

anti-HMGCR

Question 4

if statin-induced weakness does not resolve and CK remains elevated despite continuation what could be considered?

Answer 4

statin triggered autoimmune myopathy

Question 5

what are the non-statin lipid lowering therapies?

Answer 5

bile acid sequestrants
nicotinic acid (niacin)
fibric acids
ezetimibe (zetia)

Question 6

what is the MOA of bile acid sequestrants?

Answer 6

reduce reabsorption of bile acids / cholesterol in ileum

Question 7

what are the outcomes of nicotinic acid (niacin)?

Answer 7

raises HDL-C

may reduce LP(a)

Question 8

what is the primary therapeutic use of fibric acids?

Answer 8

hyperTG

Question 9

what is the main side effect of fibric acids?

Answer 9

gallstones

Question 10

what is the MOA of ezetimibe?

Answer 10

impairs dietary and biliary cholesterol absorption without affecting TG or fat-soluble vitamins

Question 11

what are the indications for ezetimibe?

Answer 11

avoid high doses of statins (synergistic)

very high LDL not sufficiently controlled statin alone

Question 12

what is the effect of CETP deficiency in atherosclerosis?

Answer 12

marked increase in HDL-C

Question 13

what is the role of CETP activity in atherosclerosis?

Answer 13

inversely correlated with plasma HDL-C

Question 14

what are the two remaining CETP inhibitors?

Answer 14

evacetrapib

anacetrapib

Question 15

what are the two options for homozygous FH?

Answer 15

mipomersen

lomitapide

Question 16

what is the MOA of mipomersen?

Answer 16

crosses hepatocyte and nuclear membrane to target apoB mRNA

Question 17

what is the MOA of lomitapide?

Answer 17

decreases production of apoB containing lipoproteins such as VLDL and subsequently LDL-C

Question 18

what is the MOA of PCSK9?

Answer 18

regulates expression of LDLr - sequesters LDLr and internalizes them for degradation

Question 19

what are the LDLr and LDL clearance levels of gain of function PCSK9 mutations?

Answer 19

low LDLr

low LDL clearance (bad)

Question 20

what are the LDLr and LDL clearance levels of loss of function PCSK9 mutations?

Answer 20

high LDLr

high LDL clearance (good)

Question 21

outcome trials show that lowering LDL levels in primary prevention is efficacious for what populations?

Answer 21

very high LDL
average LDL
diabetics
elderly

Question 22

outcome trials show that lowering LDL levels in secondary prevention is efficacious for what populations?

Answer 22

estsablished CVD regardless of baseline cholesterol levels