Treatment of dyslipidemias Flashcards
what are the 4 major statin benefit groups identified in whom CVD risk reduction clearly outweights risk of adverse events?
- secondary prevention - clinical ASCVD
- primary prevention - LDL-C over 190 mg/dL
- primary prevention - diabetics
- primary prevention - without diabetes high risk
what is the most common adverse effect of statins?
muscle complaints
statin triggered autoimmune myophaty is associated with what antibody?
anti-HMGCR
if statin-induced weakness does not resolve and CK remains elevated despite continuation what could be considered?
statin triggered autoimmune myopathy
what are the non-statin lipid lowering therapies?
bile acid sequestrants
nicotinic acid (niacin)
fibric acids
ezetimibe (zetia)
what is the MOA of bile acid sequestrants?
reduce reabsorption of bile acids / cholesterol in ileum
what are the outcomes of nicotinic acid (niacin)?
raises HDL-C
may reduce LP(a)
what is the primary therapeutic use of fibric acids?
hyperTG
what is the main side effect of fibric acids?
gallstones
what is the MOA of ezetimibe?
impairs dietary and biliary cholesterol absorption without affecting TG or fat-soluble vitamins
what are the indications for ezetimibe?
avoid high doses of statins (synergistic)
very high LDL not sufficiently controlled statin alone
what is the effect of CETP deficiency in atherosclerosis?
marked increase in HDL-C
what is the role of CETP activity in atherosclerosis?
inversely correlated with plasma HDL-C
what are the two remaining CETP inhibitors?
evacetrapib
anacetrapib
what are the two options for homozygous FH?
mipomersen
lomitapide
what is the MOA of mipomersen?
crosses hepatocyte and nuclear membrane to target apoB mRNA
what is the MOA of lomitapide?
decreases production of apoB containing lipoproteins such as VLDL and subsequently LDL-C
what is the MOA of PCSK9?
regulates expression of LDLr - sequesters LDLr and internalizes them for degradation
what are the LDLr and LDL clearance levels of gain of function PCSK9 mutations?
low LDLr
low LDL clearance (bad)
what are the LDLr and LDL clearance levels of loss of function PCSK9 mutations?
high LDLr
high LDL clearance (good)
outcome trials show that lowering LDL levels in primary prevention is efficacious for what populations?
very high LDL
average LDL
diabetics
elderly
outcome trials show that lowering LDL levels in secondary prevention is efficacious for what populations?
estsablished CVD regardless of baseline cholesterol levels
