Chemical Pathology - Lipid update Flashcards Preview

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Flashcards in Chemical Pathology - Lipid update Deck (17)
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1
Q

what did the SPRINT study find about mpdulating blood pressure?

A

aggressive management of BP and lipids improves survival

2
Q

what is the optimal medical therapy in people with CHD?

A
  • intensive lifestyle modification
  • high dose statin (atorvastatin 40-80mg OD
  • assessment for probably T2DM (HbA1c)
  • aspirin
  • optimal BP control
3
Q

what are the options for statin intolerant patients?

A
  • ezetemibe (reduced absorption - block NPC1L1)
  • plasma exchange
  • Evolocumab (PCSK9 monoclonal antibody)
4
Q

what does the PCSK9 antibody do?

A
  • regulates levels of LDL-receptor expression

- if you inhibit PCSK9 = high LDL-R on liver = low plasma LDL

5
Q

what did the FOURIER “PCSK9” study show?

A

PCSK9 inhibition reduced major CVS events
effect on mortality was insignficant
NNT was high

6
Q

how can this be linked to clinical practice?

A

reserve for high risk patients

  • statin intolerant
  • uncontrolled lipids (i.e. FH)
7
Q

how many years of good glucose control in newly diagnosed T2DM patients is needed before you see the benefits in health?

A

15 years

8
Q

what is the legacy effect?

A

having good blood glucose control, even for short while, can improve later mortality

9
Q

what did the DCCT study show?

A

T1DM

good control improves outcome and legacy effect

10
Q

what did the UKPDS study show?

A

T2DM

good control improves outcome and legacy effect

11
Q

what did the ACCORD study show?

A

suddenly aggressively controlling the blood glucose of people who had poor control for decades = reduced complications but increased mortality

12
Q

how do SGLT2 inhibitors work?

A

reduced glucose re-uptake in kidneys
osmotic diuresis (reduced blood glucose and low BP)
e.g. empagliflozin

13
Q

What did the EMPA-RED study show?

A

Study in empagliflozin
significant reduction in mortality and incidence of CV events after just 4 years
quick reduction
other areas of treatment: treat HF (diuresis), prevent neuropathy

14
Q

what does GLP-1 do?

A
  • secreted from gut L-cells
  • signals to pancreas to make insulin
  • direct effect on appetite and gastric emptying
  • incretin effect
15
Q

what breaks down GLP-1?

A

broken down by DPP4

inhibiting DPP4 using Gliptins makes GLP01 last longer e.g. sitagliptin

16
Q

name some GLP-1 analogues

A
  • exenatide
  • liraglutide
  • semaglutide
17
Q

what is the best medical management of T2DM?

A
  1. Metformin

2. Dual therapy: add on either SGLT-2 or GLP-1 analogues