Cardiac Lipid-lowering Agents

Question 1

HMG-CoA Reductase Inhibitors

“statins”

Answer 1

Inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor

Hepatotoxicity (increased LFTs)

Rhabdomyolysis (esp w/ fibrates & niacin)

Question 2

Niacin (Vitamin B₃)

Answer 2

Inhibits lipolysis in adipose tissue; reduces hepatic VLDL synthesis

Red, flushed face (give with aspirin)

Hyperglycemia (acanthosis nigricans)

Hyperuricemia (exacerbates gout)

Question 3

Bile acid resins

(cholestyramine, colestipol, colesevelam)

Answer 3

Prevents intestinal absorption of bile acids; liver must use cholesterol to make more

Patients hate it, tastes bad & causes GI discomfort

Decreased absorption of fat-soluble vitamines

Cholesterol gallstones

Question 4

Cholesterol absorption blockers

(ezetimibe)

Answer 4

Prevent cholesterol absorption at small intestine brush border

Rare increase in LFTs, diarrhea

Question 5

Fibrates

(gemfibrozil, clofibrate, benzafibrate, fenofibrate)

Answer 5

Upregulates LPL, increased TG clearance

Activates PPAR-alpha to induce HDL synthesis

Myositits (increased risk with statins)

Hepatotoxicity (increased LFTs)

Cholesterol gallstones (esp with bile acid resins)