Dyslipidemia Flashcards
What lipid level dyslipidemia refers to?
- total cholesterol (TC) > 5.2 mmol/L
- HDL-C < 1.0 mmol/L (males), <1.2 mmol/L (females)
- TG > 1.7 mmol/L
- LDL-C levels- depends on the patient’s CV risk
what are the management of very high TG concentrations (> than 500 mg/dL)?
- primary goal- prevent pancreatitis
- weight loss
- limit sugars and carbohydrates
- exercise
- pharmacologic therapy
- Fibrates, omega-3 fatty acids, and niacin will produce largest TG reductions
- Statins can also be considered first-line therapy in patients with TG levels of 500–999 mg/dL
What are the outcome of using bile acid sequestrants, PCSK9 inhibitors, niacin, fibrates and ezetimibe?
reduce LDL-C:
- bile acid sequestrants- 15-27%
- PCSK9 inhibitors- an additional 45-68% when combined with statin
- niacin- 5-25%
- fibrates- 5-20% (with normal TG)
- ezetimibe- 18-20%
raise HDL-C:
- bile acid sequestrants- 3-5%
- PCSK9 inhibitors- NIL
- niacin- 15-35%
- fibrates- 10-20%
- ezetimibe- 1-5%
reduce TG:
- bile acid sequestrants- may INCREASE TG concentrations
- PCSK9 inhibitors- NIL
- niacin- 20-50%
- fibrates- 20-50%
- ezetimibe- 5-10%
What if statin does not work?
alternative are ezetimibe, bile acid sequestrants, PCSK9 inhibitors
can niacin use concomitantly with statins?
doses greater than 1g/day increase the risk of myopathy and rhabdomyolysis
*they are commonly use together, monitor for muscle pain
can fibrates co-administered with statins?
No, can cause increased risk of myopathy and rhabdomyolysis
*risk greater with gemfibrozil than fenofibrate
what are the absolute contraindications of statins?
- Active liver disease, unexplained persistent elevations in hepatic transaminases
- pregnancy
- nursing mothers
- certain medications
What are the monitoring parameters of statins?
- Lipid profile measured at 1 to 3 months following initiation and following a change in the dose of statin therapy
- Hepatic transaminases should be measured at baseline and at 1 to 3 months after starting treatment and/or following a change in dose
- Statin-associated muscle symptoms (SAMS)
What are the general approach to initiate statin therapy?
- check fasting lipid panel
- LDL-C is higher than 5 mmol/L, evaluate for secondary causes
- primary, screen for familial hypercholesterolemia
- TG 5.6 mmol/L or higher, treat hypertriglyceridemia - check ALT
- Evaluate patients with unexplained ALT more than 3 X upper limit of normal - check hemoglobin A1c
- CK
- 2dary causes or conditions that may affect statin safety
What are the primary recommendations?
- heart-healthy diet
- DASH diet
- emphasizes consumptions of fruits, vegetables…
- limit sweet, red meats
- lower intake of saturated fats and replace with unsaturated fats (esp polyunsaturated fats) - regular exercise
- maintain healthy weight
- smoking cessation
What are the LDL-C levels to initiate drug therapy and target LDL-C levels for very high CV risk?
LDL-C levels to initiate drug therapy: >1.8 mmol/L
target LDL-C levels: < 1.8 or a reduction of >50% from baseline
What are the LDL-C levels to initiate drug therapy and target LDL-C levels for high CV risk?
LDL-C level to initiate drug therapy: >2.6 mmol/L
target LDL-C levels: < and equal 2.6 or a reduction of >50% from baseline
What are the criteria of very high risk individuals?
- established CVD
- diabetes with proteinuria/ with a major risk factor such as smoking, HPT, dyslipidemia
- CKD with GFR < 30 (stage 4)
*highest risk of CVD
What are the criteria for high risk individuals?
- diabetes without target organ damage
- CKD with GFR > and equal 30 to <60 (stage 3)
- very high levels of individual risk factors ( LDL-C > 4.9, BP >180/110 mmHg)
- multiple risk factors that confer a 10 year risk for CVD > 20% (FRS-CVD Risk Score)
*highest risk of CVD
What are the criteria of intermediate (moderate) risk individuals?
have a FRS-CVD score that confer a 10 year risk for CVD of 10-20%
