Treatment of Dyslipidemias

Question 1

What dietary factors are used in Tx of Dyslipidemias?

Answer 1

Mediterranian Diet
Fresh Fruit and Veggies 
Whole Grains 
Fatty Fish
Lean Meats 
Higher fat dairy products
Nuts

Eat the fruits and veggies first
More satiating stuff afterward
Dietary cholesterol

Question 2

What is the contribution of exercise in Tx of dyslipidemias?

Answer 2

Increase CV fitness 
Decreases LDL increases HDL
Decreases TRGs 
30-40 min 3-4x per week.
Even if they don't change in weight.

Question 3

What are the alcohol factors for Tx of dyslipidemias?

Answer 3

1-2 drinks are supposedly benificial

Question 4

What is the Tx for Familial Chylomicronemia?

Answer 4

Diet

Creamy top layer

Question 5

What is the Tx for Familial Hypercholesterolemia?

Answer 5

Cholestyramine or Cholestipol, statins, niacin

Clear

Question 6

What is the Tx for Familial Combined Hypercholesterolemia?

Answer 6

Statins, Niacin, Fibrates

Clear

Question 7

What is the Tx for Familial dysbetalipoproteinemia?

Answer 7

Fibrates, Statins

Turbid

Question 8

What is the Tx for Familial Hyperlipemia?

Answer 8

Statins, Niacin, Fibrate

Question 9

What is the Tx for Endogenous hypertriglyceridemia?

Answer 9

Niacin, Fibrate

Creamy top Tubid bottom

Question 10

What will cause a Creamy top layer appearance of serum?

Turbidity?

Answer 10

High chylomicrons.

High LDLs

Question 11

What are the visible signs of FH?

Answer 11

Xanthelasma
Corneal arcus
Ach Tendon Xanthoma
Tendon Xanthoma
Tuberous Xanthomas
Palmar Xanthomas

Question 12

What are the medical therapies for FH?

Answer 12

Statins

Question 13

What is the MOA of Statins?

Answer 13

HMG - Co A reductase Inhibitor
Reduces serum cholesterol concentration
Reduces CV events AND MORTALITY!

Question 14

What is the mechanism of benefits of Statins?

Answer 14

Reg of AS
Plaque stabilization
Red Inflammation
Dec Thrombogenicity
Reversal of Endothlial Dys

Question 15

What are the 4 reccomended groups in statin therapy?

Answer 15

1) Secondary Prevention-clinical ASCVD
HIT to MIT
2) Primary Prevention-primary LDL>190 mg/dL
HIT
3) Primary Prevention- Diabetics LDL 70 to 189
MIT or HIT
4) PRimary Prevention- No diabetes but 10 yr CVD risk >7.5% 40 to 75yo
MIT or HIT

Question 16

What are the Low
Medium and
High Intensity Statins?

Answer 16

Low: PRavastatin, Lovastatin
Med: Atorva, Rosuva, Simva, Prava,Lovastatin
High:Atorva, Rosuvastatin

Question 17

What are the AA of Statins?

Answer 17

Diabetes(insulin resistance)
Muscle: Rhabdomyolysis(CK), Caused by depleted Q10?
GEMFIBROZIL has higher risk of muscle complaints
Hepatic
CNS-memory loss
GI-loose stools

Question 18

What are the categories of Statin muscle complaints?

Answer 18

Myalgia
Myopathy
Myositis
Myonecrosis
Rhabdomyolysis

Question 19

What is Statin triggered autoimmune myopathy?

Answer 19

Weakness doesnt resolve and CK remains elevated despite discontinuation
anti-HMGCR autoantibody
Tx with immunosupressives(IVIG) prednisone

Question 20

What are non statin lipid lowering treatments?

Answer 20

Bile acid Sequestrants
Nicotinic acid
Fibric Acids
Eztimibe

Question 21

What is the MOA of Bile acid Sequestrants?

Answer 21

Keeps bile acids from being reabsorbed
Forces the body to use its own cholesterol to make more.
May increase TRGs

Question 22

What is the MOA of Nicotinic acid?

Answer 22

Raises HDL
Reduced LPa
SA Flushing, hyperglycemia, gout
No reduction in events :-(

Question 23

What is the MOA of Fibrates?

Answer 23

Used for hyper triglyceridemia
Lower TG
Causes GALLSTONES, dyspepsia, myopathy
Doesn't benefit T2 Diabetics or those taking statins
(DONT TAKE WITH STATINS!)

Question 24

What is the MOA of Ezetimibe?

Answer 24

Impairs dietary and biliary cholesterol abs without affecting TG or FSV.
When used with a stain will increase benefit

Question 25

What OTC and Dietary supps can be used?

Answer 25

``` Fish oil (reduces TRGs) Soy Garlic Red Yeast rice Chol lowering Margarines (bind to cholesterols) Add Soluble fiber to diet ```

Question 26

What are med and Comorbid disease effects on lipids?

Answer 26

``` Meds:Thiazides Estrogen B Blockers Steroids Protease Inhibitors Comorbidities: Very high LDL Elevated TRG Diabetes Mellitus ```

Question 27

What are the CETP Inhibitors?

Answer 27

Anacetrapib | Lots have been removed for SA and most dont decrease risk of events!

Question 28

Options for Homozygous FH?

Answer 28

Mipomersen: Blocks Transcription/ translation of Apo B lipoprotins Lomitapide: MTP inhibitor Prevents assembly and secretion of Apo B

Question 29

What are the PCSK 9 molecules?

Answer 29

Locks action of LDL receptors Reduces LDL So far no dose limiting toxicities