Flashcards in Foundations-Hyperlipidemia Deck (70):
List the two types of lipids
Role of cholesterol
helps form steroid hormones & bile acids
Role of Triglycerides
helps transfer energy from food to cells
How are lipids transported
How are lipoproteins classified?
1. Low density= more triglycerides
2. High density= more apoproteins (contains proteins)
Define Primary Prevention
Pt's without evidence ASCVD
Define Secondary Prevention
-Goal is to prevent 2nd CV event
How is cholesterol carried? Equation...
Total cholesterol= HDL + VLDL + LDL
What do most clinical laboratories MEASURE?
How do you calculate VLDL cholesterol?
LDL-Chol= (total cholesterol)- (HDL-Chol)- (Tg/5)
What is a normal triglyceride level
What is the first step in plaque formation?
Oxidation of LDL
What symptom would you expect to see with obstructive atherosclerotic plaque?
What does the ACC/AHA CVD risk score include that the "hard" coronary framingham risk score doesn't?
-Race (AA or other)
What is the optimal LDL cholesterol level?
What is high LDL cholesterol level?
What is very high LDL cholesterol level?
> or equal to 190
What is the LDL goal for those with CAD?
What is the desirable cholesterol level?
What is high cholesterol level?
> or equal to 240
What is low HDL for men?
What is low HDL for women?
What is high HDL?
> or equal to 60
How long do you have to fast for to check lipoprotein levels?
What are the major risk factors (other than LDL)-->Step 3 in ATP III guidelines
-Family hx of premature coronary dx
What is the LDL Goal for pt's with a 10-year risk > or equal to 20%
At what LDL level do you initiate TLC for pt's with a 10-year risk > or equal to 20%
> or equal 100
At what LDL level do you consider drug therapy for pt's with a 10-year risk > or equal to 20%
> or equal 130
What is the LDL Goal for pt's with a 10-year risk < or equal to 20% WITH 2+ risk factors
At what LDL level do you initiate TLC for pt's with a 10-year risk < or equal to 20% WITH 2+ risk factors
> or equal 130
At what LDL level do you consider drug therapy for pt's with a 10-year risk < or equal to 20% WITH 2+ risk factors
10 yr risk 10-20%= > or equal 130
10 yr risk <10%= > or equal 160
What is the LDL goal for 0-1 risk factor?
What LDL level do you initiate TLC for 0-1 risk factors
> or equal 160
What LDL level do you consider drug therapy for 0-1 risk factors
How much can maximizing TLC reduce LDL?
List the Metabolic Syndrome Risk factors
1. Abdominal obesity
-Waist circumference >40 men
-Waist circumference >35 women
2. Triglycerides >150
3. Low HDL
4. Increased BP- >or equal 130/85
5. Impaired fasting glucose >100 mg
*3 or more=metabolic syndrome
What is a high triglyceride range?
What is a very high triglyceride level?
> or equal 500
If triglycerides are > or equal 500, why should you first lower triglycerides?
to prevent pancreatitis
What is the ACC/AHA 2013 screening age recommendation
> or equal 21 yrs
List the 4 major groups of ppl who should be treated with STATINs
1. Anyone w/ ASCVD
2. Extremely elevated LDL, >190
3. 40-75 y.o w/ DM w/ LDL 70-189
4. 40-75 w/ 10 year risk > or equal 7.5% per new risk calculator
How much does high intensity treatment reduce LDL?
List the two statins recommended for high intensity treatment
1. Atorvastatin 40 or 80 mg
2. Rosuvastatin 20 or 40 mg
How much does moderate intensity treatment reduce LDL?
List the three statins recommended for moderate intensity tx
1. Atorvastatin 10-20 mg
2. Simvastatin 20-40 mg
3. Pravastatin 40 mg
ALL TLC combined can decrease your LDL by how much?
What are the overall benefits of statins?
-Fatal and non-fatal MI
-Incidence of CVA
-ALL causes of mortality
Why are statins best dosed at night?
Cholesterol is synthesized at night
What enzyme do statins inhibit?
HMG-COA reductase inhibitors
How much do statins decrease LDL?
Contraindications to statins
2. Active liver dz
3. unexplained elevated LFTs
Major side effects of statins
Increased diabetes risk
What is the MOA of statins?
inhibit the rate-limiting enzyme in the formation of cholesterol
What is the MOA of cholesterol absorption inhibitor
Decreases absorption of cholesterol in small intestine, upregulates LDL receptors on peripheral cells
List an example of a cholesterol absorption inhibitor?
How much do cholesterol absorption inhibitors decrease LDL?
Contraindications to cholesterol inhibitor absorption inhibitors?
-Do not use with fibrates
What is the MOA of fibric acid derivatives?
Reduced synthesis and increased breakdown of VLDL particles
List examples of f fibric acid derivatives
What is the drug of choice for TG >500
How much do fibric acid derivatives decrease TG?
Contraindications to fibric acid derivatives
Not recommended with statin use
What drug would you prescribe for moderately high LDL and very low HDL?
What is considered the only safe lipid-lowering medication in pregnancy?
Bile-Acid binding resins
List examples of bile-acid binding resins
cholestyramine, colesevelam, colestipol
MOA of PCSK9 inhibitors
Blocks PCSK9 effects of degrading LDL receptors= more receptors that are continually active so MORE LDL is bound
How much does PCSK9 inhibitors lower LDL
What genetic disorder has absent or dysfunctional LDL receptors?