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Clinical 2.0 > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

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1
Q

what is hyperlipidemia an independent risk factor for

A

coronary heart disease: angina, mi
cerebrovascular disease: ischemic stroke, tia
peripheral artery disease

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2
Q

modifiable risk factors for CVD

A 
smoking 
hypertension 
diabetes
bmi>27 
excessive alcohol 
poor nutrition
sedentary lifestyle 
waist circ <94 men <80 women
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3
Q

non modfiable risk factors for CVD

A 
old age 
male
family history of premature CHD <55male or <65 female 
family hypercholesterolemia 
chronic kidney disease
ethnicity
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4
Q

four reasons to do a risk assessment

A
  1. identify patients most likely to benefit from pharmacotherapy**
  2. reassure low risk individuals without any treatable risk factors and a healthy lifestyle that theyre doing well
  3. advise individuals with treatable reisk factors and behaviours to address them
  4. engage patients in treatment decisions and increase adherance to therapy**
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5
Q

what is CVD

A 
coronary death 
mi 
coronary insufficiency 
angina 
ischemic or hemorrhagic stroke 
transient ischemic attack 
peripheral artery disease
heart failure
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6
Q

what are the advantages of ACC/AHA ASCVD

A

broader pop

narrower outcomes

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7
Q

what age group should we screen in

A

men and women over 40 years or postmenopausal (typically women not at CVD risk at this age)

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8
Q

describe LDL

A

low density
bad
high levels in the blood promotes build up of plaque in the artery walls

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9
Q

describe HDL

A

helps carry ldl away from artery walls

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10
Q

what are healthy lipid values

A

total chol; <5.2
ldl: <3.4
hdl >1 in men >1.3 women
tg <1.7

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11
Q

what are the effects of non fasting lipid profiles

A

min effect on LDL and HDL
modest effect on TG
predicts CVD similar to fasting
increases adherence, decrease lab demands and hypoglycemia

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12
Q

drug causes of hyprecholesterolemia

A 
progestins
thiazides - not sig 
anabolic steroids
glucocorticoids
beta blockers - not sig 
isotretinoin 
protease inhibitors
cyclosporin 
mirtazapine
sirolimus
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13
Q

genetic and condition causes of dyslipidemia

A 
familial hypercholesterolemia 
type 2 diabetes
chronic renal failure 
hypothyroidism 
nephrotic syndrome 
cholestatic liver disease
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14
Q

lifestyle causes of dyslipidemia

A 
saturated fats increase lipids 
refined cabs and sugars increase triglycerides 
smoking decreases hdl 
aerobic increase hdl 
moderate alcohol increases hdl
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15
Q

name 3 things that cna positively affect lipid profile and decrease the risk of cv events

A

physical activity : 150 min/week
diet : mediterranean
stop smoking

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16
Q

torcetrapib decreases ldl significantly but whats wrong with it

A

increased CVD and mortality rates

not an improved outcome

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17
Q

what is the relative risk reduction with a statin***

A

25-30%

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18
Q

statins considered the same for efficacy, harm, and cost but differ in drug interactions, list from most to least

A

simvastatin and lovastatin > atorvastatin > pravastatin and rosuvastatin

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19
Q

what dose to start

A

equivalent to 10mg atorvastatin

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20
Q

many trials with statins had similar risk reductions using atorvastatin 10mg what didnt they target

A

did not target ldl, nor did they increase or decrease meds to reach the target, nor did they compare one ldl target to another

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21
Q

what does the top 2015 study recommend for primary prevention based on risk

A

risk <10% retest lipids with risk estimation in 5 years
10-19% risk discuss and offer statins
>20% risk encourage high intensity statins
** do not retest lipid levels or try reach targets

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22
Q

compare canadian prevention guidelines: CCS and ACC/AHA

A

both agree to initiate therapy if LDL>5, or diabetes
but ACC/AHA opens up discussion with patient and estimates atherosclerotic cardiovascular risk before deciding to intiate therapy

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23
Q

general side effects of statins

A 
muscles aches
GI upset
upper GI 
sleep disturbance
new onset diabetes - very low
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24
Q

describe the statin myopathy

A

muscle discomfort - weakness, cramps, heaviness
usually starts in larger muscles
diffuse - not unilateral
intermittent of variable duration

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25
when does statin myopathy occur
1-12 months of therapy, or after dose increase, addition of interaction of drug
26
describe the management of myalgia
obtain CK level - hold statin? hold for 1-2 weeks or until symptoms resolve then rechalenge statin, different statin/dose reduction, reasses risk vs benefit of restarting statin
27
what is myositis
inflammation of skeletal muscle, muscle discomfort myalgia plus plasma CK levels >2-4ULN but <10xULN may be caused be strenuous exercise potentially serious
28
describe the management f myositis
>2ULN but <10ULN : discontinue statin follow until symptoms resolve/CK normal consider precipitating factors reasses risk vs benefit before restarting stain change statin/reduce dose/titrate up slowly
29
what is the serum creatinine in rhabdomyolysis
``` ck> 3-10x ULN and marked creatinine elevation or myoglobinuria (orange color urine) ```
30
describe rhabdomyolysis | symptoms and complications
severe progressive muscle aches, weakness, pain muscle damage, mypglpburia, high risk of acute renal failure medical emergency! very rare
31
management of rhabdomyolysis
stop statin and hospitalization for supportive treatment
32
should you re initiate a statin after rhabdomyolysis
may rechallenge with low dose of diff statin once symptoms resolved - may take months to years reassess risk vs benefit alternative ldl lowering therapy
33
should you use coenzyme q or vit d to decrease myopathies
no
34
what do the ccs guidelines recommend for retesting if not on a statin
Cv risk assessment every 5 years for men and women 40-75, also a risk assessment
35
what does top 2015 recommend for retesting if not on a statin
no more than every 5 years, sooner if other cv risk factors develop
36
what is the time to 10% probability of crossing the FRS 20% high risk line in 1. FRS < 5% 2. FRS 5- <10% 3. 10- 15%
1. 19 years 2. 8 years 3. 3 years
37
who is in the high risk category
``` FRS > 20 clinical vascular disease abdominal aortic aneurysm chronic kidney disease high risk hypertension diabetes and >40, or >15 yrs duration and >30, or microvascular disease ```
38
if someone has a 5% risk of CHD death, MI, or stroke over 10 years what would a statin decrease it to? how many events would it save in 10 years
3. 7% | 1. 2 events?
39
what does ccs recommend for diabetes for statin therapy
all start on a statin
40
what do statins do
relative risk reduction of chd event or death 25% | mortality: NNT 30 x 5-6 years
41
what was the difference found from a big dose statin compared to a smal
additional 10% relative risk reduction (1% absolute risk reduction) in CHD events or death
42
what are questions to ask to determine if muscle pain due to the statin
any change in the urine is it getting better - not statin have you had this in the past is it bilateral - statin
43
what is a food interaction with statins
grapefruit
44
what are drug interactions with statins
``` azole antifungal cyclosporin macrolide antibiotics amiodarone warfarin fibrate HIV protease inhibitor verapamil diltiazam ```
45
what is the result of adding niacin or fibrates with a statin
not significant in any outcome
46
how effective are fibrates
half as good as statins
47
what is the improve-it trial
improved reduction of outcomes vytorin efficacy international trial 1800 post mi patients
48
what was the intervention in the improveit trial
simva 40mg +ezetimibe vs simva alone for 7 years
49
what are the results of the improveit trial
decrease ldl by 15-20% slight reduction in sv events, death, mi, stroke no big differences in safety
50
when would you offer an ezetimibe
had an mi and only tolerate half dose of statin if patient thinks its worth it for a 2% risk reduction
51
what are pcsk9 inhibitor
monoclonal antibodies
52
how much did ldl decrease with pcsk9 inhibitors
50-70%
53
what did the fourier trial study
evolocumab and clinical outcomes in patients with cardiovascular disease on a statin for 2.2 yeas
54
what was the outcome of the fourier trial
reduced events from 5.1 - 4,5% | did not reduce deaths
55
should you use pcsk9 inhibitors
not a significant enough decrease in cv events and does not reduce deaths and very very costly
56
niacin effects on cvd
decrease triglycerides 20-35% | stopped due to futility no decrease in cvd risk
57
fibrates effects on cvd
decrease triglycerides by 20-50% | decrease non fatal mi no difference in overall cvd
58
omega 3 fatty acids effect on cvd
decreased triglycerides 25-30% no benefit in ay cv outcome
59
overall what can be said about lowering triglycerides
doesnt decrease cvd events
60
what are high tg a risk factor for
pancreatitis
61
what did jama find about statins and fibrates in pancreatitis
statins decrease pancreatitis, fibrates increased
62
compare TOP to ACC/AHA guidlines
TOP based on framingham risk alone

Clinical 2.0 (24 decks)

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