CAD & Lipids Flashcards
epidemiology of ASCVD
CVD is the #1 Killer of both men and women
More women die of CVD than men
More women die of CVD than cancer, chronic lower respiratory diseases, alzheimer’s, accidents & diabetes combined
Describe the role of inflammation in the development of ASCVD
A plaque becomes unstable due to inflammation
modifiable and non-modifiable risk factors for ASCVD
Dyslipidemia smoking HTN Diabetes Obesity Diet sedentary lifestyle age sex family hx
PCSK9 inhibitors
Alirocumab & Evolocumab
reduce the degradation of hepatic LDL receptors so lower LDL
Very expensive
Injectable SQ q 2 weeks
recommended follow up labs for statin mgt monitoring
Repeat lipids every 4-12 weeks after to monitor adherence and biologic response.
Repeat lipids every 3-12 MONTHS therafter although not necessary if medication compliant.
CK and ALT are not recommended unless patient has symptoms.
Describe what non-HDL cholesterol measures and its implications
The difference between the total and the HDL-C.
Its implications are less risk
Define the four major statin benefit groups identified in 2013 AHA/ACC Cholesterol Guidelines
1 - Established artherosclerosis
2 - LDL >190
3 - Diabetics 40-75
4 - 10 yr ASCVD risk >7.5%
Very High-Risk* of Future ASCVD Events
Recent ACS (within past 12 mo)
Hx of MI (other than ACS above)
Hx of stroke
symptomatic PAD (hx of amputation, revasc or claudication with ABI <0.8)
High-Risk* of Future ASCVD Events
Age >/= 65 familial hypercholesterolemia Hx of prior coronary artery bypass or intervention outside of the major ASCVD event DM HTN CKD (eGFR 15-59) Current smoking Persistent elevated LDL-C despite max tolerated statin and ezetimibe
Describe the possible use of coronary artery calcium (CAC) scoring in 2018 guidelines
If CAC is zero, lowers risk, consider no statin, unless DM, hx of premature CHD or smoking are present)
If CAC = 1-99 favors statin (esp after age 55)
If CAC = 100+ and/or >= 75th percentile, initiate statin
High intensity statins
LDL-C reduction >50%
atorvastatin 40-80mg
rosuvastatin 20-40mg
Moderate intensity statin
LDL-C reduction 30% - <50%
atorvastatin 10-20mg rosuvastatin 5-10mg simvastatin 20-40mg pravastatin 40-80mg lovastatin 40mg fluvastatin XL 80mg fluvastatin 40mg BID pitavastatin 2-4mg
Moderate intensity statin
LDL-C reduction <30%
simvastatin 10mg pravastatin 10-20mg lovastatin 20mg fluvastatin 20-40mg pitavastatin 1mg
GLOBAL RISK????
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