HLD

Question 1

What are 2 scenarios where you should STOP using the ASCVD score for patients?

Answer 1

1) If the patient has known ASCVD disease…as it is no longer primary prevention, but secondary and ASCVD is for primary prevention.
2) If the Pt has an LDL > 190

Question 2

For primary prevention of a diabetic patient: What criteria should be used to determine if statin is needed, and determine which intensity of statin is needed?

Answer 2

Diabetic Type 1 or 2
Between the Age 40 -75
With LDL 70-189

Calculate ASCVD:
if < 7.5% == Moderate Intensity statin
if > 7.5% == High Intensity statin

Question 3

For primary prevention of a NON-diabetic patient: What criteria should be used to determine if statin is needed,

Answer 3

Age 40-75
LDL 70-189

If ASCVD > 7.5% – give either moderate or high intensity statin.

Question 4

What medications (2) and conditions (3) can often causes secondary elevation of LDL-C?

Answer 4

1) Diuretics
2) Amiodarone

1) Biliary Obstruction (ex: PBC, PSC)
2) Nephrotic Syndrome (ex: MM)
3) Hypothyroidism

Question 5

What medications (6) and conditions (4) can often cause secondary elevation of TGs?

Answer 5

1) Oral Estrogen
2) Beta-Blockers (except Coreg/Carvedilol)
3) Thiazides
4) Anabolic Steroids
5) Protease Inhibitors
6) Tamoxifen / Raloxifene

1) Nephrotic Syndrome
2) CKD/Renal Failure
3) Uncontrolled DM
4) Hypothyroidism

Question 6

Which Coronary Artery Calcification (CAC) Score is considered “increased risk” and could indicate need for starting a statin?

Answer 6

CAC —– > 300 Agastons OR > 75th Percentile.

Question 7

At what levels should you have concern for muscle or liver damage 2/2 statin use?

Answer 7

MSK — If CK is >/= 5x ULN

Liver — If LFTs are > /= 3x ULN

Question 8

How should you initially check lipids? When should you check Lipids again after starting treatment?

Answer 8

Check Lipids NON-fasting 2x (separated by 1 week)

*Only need fasting if TGs = > 400

Check Lipids again at 8 week after starting therapy (+/- 4 weeks). If at goal, can then check annually.

Question 9

What labs should you check if a patient has c/o of statin intolerance (ie: Myalgias, etc)

Answer 9

1) CK
2) TSH (checking for hypothyroidism)
3) Vit D 25 levels (Vit D defficiency is associated with inc. statin intolerance).