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Flashcards in Dislipidemia Deck (71)
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1

Dyslipidemias include?

High LDL

Low HDL 

High TG

2

Chylomicrons?

  • Transport fatty acids and cholesterol from the intestine to the liver
  • TG rich
  • Clears from the blood stream within 12 hours 

3

Lipoprotein Analysis should be done when patient has?

Fasted for 9-12 hours 

4

Along with age and family history risk factors for CHD include?

Hypertension or on HTN meds

Low HDL 

male- <40mg/d

FM- <50 mg/dl

5

C-reactive protein or CRP is what type of marker?

What are the ACC/AHA guidelines?

Inflammatory marker

hsCRP

< 1 mg/l= low risk

1-3= moderate

>3 is high risk 

6

Normal levels of Lp (a) are?

How can it be treated?

< 30 or 75 nmol/L 

Niacin, Estrogens, PCSK9-I

7

Vit D insuffieciency is linked to?

CHD and total mortality 

8

Combined cholesterolemia is?

High TG and Cholesterol

9

Mixed Dyslipidemia is?

High TG and low HDL

10

What are the two types of Familial Hypercholesterolemia?

Heterozygous 

Homozygous

11

What are the secondary causes of Hypercholesterolemia?

  1. DM
  2. Obese
  3. Alcohol
  4. Hypothyroidism 
  5. HIV
  6. Liver impairment
  7. CKD
  8. Pregnancy
  9. Menopause
  10. Autoimmune dissorders

12

LDL-C 

Desirable?

 

very high

 

<100

 

>190

13

TG levels?

Normal? 

 

very high?

<150

 

>= 500

14

Non HDL Cholesterol

Desirable?

 

Very high

<130

 

>= 220

15

Drug induced Dyslipidemia?

Thiazides

BBs

Estrogens

Atypical 

Steroids

Cyclosporine

Protease inhibitors 

Retinoids

  • ^LDL and TGs
  • Decrease HDL, ^ TGs
  • ^HDL and TGs, decrease LDL
  • decrease HDL  ^TGs
  • ^LDL and TGs
  • ^LDL and TGs
  • ^LDL and TGs, Decrease HDL
  • ^LDL and TGs, decrease HDL

16

The 2013 ACC/AHA Guideline Key Points?

  1. Encourage adherence of a heart healthy lifestyle
  2. Statins are recommended for adults in groups demonstrated to benefit
  3. Engage in Clinic patient discussion before initiating statin therapy 
  4. Initiate the appropriate intensity of statin therapy to reduce ASCVD risk
  5. Used Pooled cohort equation for estimating 10-ASCVD risk
  6. Evidence is inadequate to support specific LDL ot non HDL goals
  7. Nonstatin drug therapy may be considered in selected individuals  

17

NHLBI

Recommendations based on RCT evidence

Less expert opinion than in prior guidelines 

18

The changes from ATP-III

  • Dont focus on specific LDL or non HDL goals 
    • Obtain a lipid panel to monitor adherence 
  • Use medications proven to reduce ASCVD risk 
    • Moderate to high intensity statin 
  • Four Statin-Benefit groups
  • Risk decisions in primary prevention
    • Optimal lifestyle 
    • Clinic patietn discussion-shared decision making

19

What is the first statin benefit group?

Clinical ASCVD

  • MI, Angina, Revascularization
  • Stroke
  • Peripheral Vascular Disease

20

2nd Statin benefit group?

LDL-C >= 190 and >= 21 years 

21

3rd statin benefit group?

DM: Age 40-75 years, LDL-C 70-189 mg/dL

22

4th statin benefit group

Primary Prevention 

  • Risk calculator >= 7.5% 10 year 
    • No DM 
    • Age 40-75 
    • LDL-C 70-189 mg/dL

23

Summary of statin initiation recommendation to Reduce ASCVD risk

Is the patient older than 21 and have ASCVD?

If so is the patient older than 75?

 

if older than 21 and less than 75 initiate high-intensity statin therapy 

Patient is greater than 75 or not a canidate for High-intensity initiate moderate intensity 

24

Summary of statin initiation recommendation to Reduce ASCVD risk

Does the patient not have ASCVD? 

 

Then if patient has a LDL >=190 initiate high intensity therpay

If it is not that high but the patient has DM with an LDL 70-189 age 40-75 Initiate moderate statin 

But if the patient calculated risk is >=7.5% then initiate high intensity therapy 

25

Summary of statin initiation recommendation to Reduce ASCVD risk  

If the patient does not fit initial criteria move to primary prevention 

 

If patient if patient has LDL 70-189 and not receiving statin therpay 

Calculate their 10 year risk factor 

If >= 7.5% Moderate to High intenesity

5-less than 7.5 Moderate intensity

But during this time Clinicial-patient discussion must be made to decide if statin is the best choice for the patient. If no Encourage healthy lifestyle and manage other risk factors 

IF yes to statin do the same and initiate appropriate statin intensity. 

26

High intensity statin therapy include what two drugs and what doses?

Atorvastatin 40 up to 80 mg 

Rosuvastatin 20 up to 40 mg 

27

Moderate intensity statin therapy drugs

 

Atorvastatin 10

Rosuvastatin 5 

Simvastatin 

Pravastatin 

lovastatin 

Fluvastatin 

28

Low intensity statin therapy?

Pravastatin 20 mg lower than moderate

Lovastatin 20mg loser than Moderate

29

ASCVD risk estimator 

>= 7.5%?

Moderate high intensity statin

30

Patients not in the benefit group what helps make clinical decisions?

  • Familial Hx
  • Elevated lifetime risk
  • LDL >= 160 
  • CRP >= 2.0 
    • CAC score >= 300