Flashcards in Dyslipidemia-Jacobsen Deck (27):
Chronic kidney disease is an independent risk factor for CV disease
more advanced CKD=higher CVD risk
Dyslipidemia and CKD
Dyslipidemia is common in CKD, but isn't universal
What are the major determinants of whether or not a CKD patient will have dyslipidemia?
Severity of proteinuria-->more protein in urine-->more dyslipidemia
Use of immunosuppressants
What is nephrotic syndrome?
gross amounts of protein in urine
LDL is widely used as a predictor for future risk, but in CKD patients LDL is ____ for assessing CV risk
LDL is not suitable for assessing CV risk in CDK patients
Why isn't CKD included in the ASCVD 10-year risk calculator?
CKD was considered CV risk equivalent. this means the risk of having a MI is so high in these patients, it's equivalent to already having had an MI
in >50 year old patients with GFR do statin/ezetimibe combo
Look at KDIGO guidelines
statin therapy in patients with CKD has similar effects to patients without CKD
non-statin therapy not covered in KDIGO 2013
simvastatin/ezetimibe vs. placebo
Non-dialysis patients-->22% RRR
Dialysis patients: no difference between treatment group vs. placebo
Statin Dosing in CKD if GFR>60ml/min:
basically any dose
Statin dosing if in CKD if GFR
adjustments are made
What drug should you avoid in patients with CKD?
When should renal status be evaluated in patients starting fenofibrate?
before initiation, within 3 months of initiation and every 6 months thereafter
high intensity statin vs. lower intensity
no difference between the two
Elderly Treatment Options:
statins-preferred because most evidence
BAS-problems with intolerance and DDI
Fibrates-dose adustment in CKD and may increase risk of gallstones in elderly
Zetia-considered safe and equally as effective as in younger patients
What are the characteristics predisposing patients to statin adverse effects:
>75 years old
multiple serious comorbidities
history of statin intolerance or muscle disorders
unexplained ALT elevations >3x upper limit of normal
What's the criteria for metabolic syndrome?
waist circumference >40 for men and greater than 35 for women
elevated TGs (>150 )
reduced HDL (130/85)
elevated fasting glucose (>100)
Preferred treatment of dyslipidemia in metabolic syndrome patients?
adding fibrates and niacin hasn't shown to improve outcomes
statins still first line unless TG >500mg/dL
Which medication is recommended to add to a statin is dyslipidemia in diabetic patients?
zetia + moderate intensity statin therapy provides additional CV benefit over moderate intensity statin therapy alone.
consider for patients with ACS and LDL>50 who can't tolerate high intensity statin
Generally, statin/fibrate combo isn't recommended because it doesn't improve ASCVD outcomes. When might you consider this therapy though?
for men with both high TG's and high HDL
DONT do combo statin/niacin
may increase chance of stroke
Is statin therapy contraindicated in pregnancy?
What are high-level risk factors for a child to develop dyslipidemia?
hypertension with medications
BMI >97th percentile
high risk conditions