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A - Step II Secrets > Cholesterol > Flashcards

Flashcards in Cholesterol Deck (9)
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1

When is cholesterol screening done?

every 5 years once a person turns 20 years old

Start sooner and screen more frequently for patients who are obese and/or with a family history of hypercholesterolemia.

2

Why is cholesterol so important?

it is a modifiable risk factor for atherosclerosis, which is involved in about 50% of all deaths in the US and 1/3 of deaths between ages of 35-65, is the most important cause of permanent disability, and accounts for more hospital days than any other illness 

3

What physical findings will clue you into hypercholesterolemia? 5

Xanthelasma
(soft, yellow plaques involving the lower eyelid)

Tendon xanthomas
(cholesterol deposits in the skin, classically over tendons in the lower extremities)

Corneal arcus in younger patients

"milky"-appearing serum

obesity 

4

What are the current recommendations for management of cholesterol levels?

LDL is usually the deciding factor for treatment decisions: 

5

List the major risk factors for coronary heart disease (CHD).

  • Age (men > 45; women > 55, or with premature menopause and no estrogen replacement therapy).
  • Family history of premature heart attacks (MI or sudden death in father or first degree male relative < 55 or mother or first degree female relative < 65)
  • Smoking
  • HTN (≥140/90 mm Hg or on anti-HTN meds)
  • Diabetes mellitus
  • Low HDL (<40 mg/dL)
    • HDL >60 mg/dL is considered protective and negates one risk factor

6

How is LDL calculated?

LDL = total cholesterol - HDL - TG/5

7

Describe the treatment for hypercholesterolemia.

  1. start with lifestyle modifications - always - before initiating drug therapy
  2. HOWEVER, if the patient has CAD or CAD-equivalent (DM, PVD) + LDL >100, then initiating drug therapy is indicated
    • 1st line: HMG CoA reducatse inhibitor 
    • 2nd line: niacin, ezetimibe, cholestyramine (bile acid-binding resin)

8

How is HDL affected by alcohol?

Estrogens?

Exercise?

Smoking?

Progesterone?

alcohol: increase (moderate intake), decrease (excess intake)

exercise: increase

estrogen: increase

smoking: decrease

androgens: decrease

progesterone: decrease

hypertriglyceridemia: decrease

9

What causes hypercholesterolemia?

Genetics + multifactorial: 

western diet, inactive lifestyle

uncontrolled diabetes

hypothyroidism

uremia

nephrotic syndrome

obstructive liver disease

excess alcohol intake (increases TG)

medications (OCs, steroids, thiazides, ß blockers)