Hyperlipidaemia Flashcards
What is considered very high risk which requires secondary prevention?
ASCVD
What is considered very high/high risk which requires primary prevention?
Familial hypercholesterolaemia (FH), DM, CKD
What should you do if there are no very high or high risk factors?
Calculate 10 year risk score using SG-FRS
Using the SG-FRS, what risk score is considered:
- high risk
- intermediate risk
- borderline risk
- low risk
- high risk: > 20%
- intermediate risk: 10-20%
- borderline risk: 5-<10%
- low risk: <5%
If no comorbidities and LDL-C < 4.9, what is the target LDL-C for patients of:
- high risk
- intermediate risk
- borderline risk
- low risk
- high risk < 1.8 mmol/L
- intermediate risk < 2.6 mmol/L
- borderline risk: < 3.4 mmol/L
- low risk: < 3.4 mmol/L
If no comorbidities and LDL-C < 4.9, what is the preferred treatment for patients of:
- high risk
- intermediate risk
- borderline risk
- low risk
- high risk: maximally-tolerated statin +- ezetimibe
- intermediate risk: moderate-intensity statin esp if risk enhancers present
- borderline risk: risk-benefit discussion for a statin if risk enhancers present
- low risk: lifestyle intervention, risk-benefit discussion if LDL-C persistently > 4.1
If ASCVD & LDL-C > 4.9, what is the target LDL-C? (different conditions)
- with ACS (MI, unstable angina): < 1.4 mmol/L
- without ACS: < 1.8 mmol/L
If ASCVD & LDL-C > 4.9, what is the preferred treatment?
- maximally-tolerated statin +- ezetimibe
- PCSK9 inhibitor if LDL-C ≥ 1.8 despite first option, esp post-ACE, recurrent ASCVD, polyvascular disease or FH
If FH & LDL-C > 4.9, what is the target LDL-C? (different conditions)
- if >40y or additional CV risk factor (DM, HTN, smoking etc): < 1.8 mmol/L
- if ≤40y & no additional CV risk factor: < 2.6 mmol/L
If DM & LDL-C > 4.9, what is the preferred treatment? (different conditions)
- additional DM-specific risk factors (CKD, multiple microvascular complications, DM > 10y, glycemic level persistently above target despite optimal tx): maximally-tolerated statin +- ezetimibe
- no additional DM-specific risk factors: at least moderate-intensity statin
If CKD & LDL-C > 4.9, what is the preferred treatment?
moderate-intensity statin +- ezetimibe in non-dialysis dependent pts
If FH & LDL-C > 4.9, what is the preferred treatment?
- maximally-tolerated statin +- ezetimibe
- PCSK9 inhibitor if LDL-C ≥ 2.6 despite first option
If DM & LDL-C > 4.9, what is the target LDL-C level? (diff conditions)
- additional DM-specific risk factors (CKD, multiple microvascular complications, DM > 10y, glycemic level persistently above target despite optimal tx): < 1.8 mmol/L
- no additional DM-specific risk factors: < 2.6 mmol/L
If CKD & LDL-C > 4.9, what is the target LDL-C?
eGFR < 60 +/ ACR ≥3: < 2.6 mmol/L
If LDL-C > 4.9 but not FH (no other comorbidities), what is the target LDL-C?
Calculate 10y SG-FRS to determine target
If LDL-C > 4.9 but not FH (no other comorbidities), what is the preferred treatment?
at least moderate-intensity statin
How much do the following statins reduce LDL-C by:
- high-intensity statin
- moderate-intensity statin
and give examples
- high intensity: ≥50% reduction (atorvastatin 40-80mg, rosuvastatin 20-40mg)
- moderate intensity: 30-49% (atorvastatin 10-20mg, lovastatin 40-80mg, rosuvastatin 5-10mg, simvastatin 20-40mg)
MOA of statins?
Inhibit HMG-CoA reductase -> inhibit cholesterol synthesis in liver -> liver takes up more LDL to be destroyed (up regulation of LDL receptor) -> reduce LDL in bloodstream
Should statins be used in pregnancy?
No (generally avoided)
Lifestyle modifications for lipid management?
- healthy diet (avoid trans fat, replace saturated fat with polyunsaturated fat, reduce calories/refined sugar)
- physical activity
- healthy weight
- smoking cessation
- limit alcohol intake (abstain if TG ≥ 4.5 or history of pancreatitis)
Rank the potency of statins from weakest to strongest
lovastatin < simvastatin < atorvastatin < rosuvastatin
PCSK9 inhibitors MOA and examples?
MOA: inhibit PCSK9 (which breaks down LDL receptors) -> more cellular uptake of LDL from plasma
Examples: evolocumab, alirocumab
Rank the potency of lipid therapies from lowest to highest LDL lowering
ezetimibe < statin < PCSK9 inhibitor
What is considered ASCVD? (8)
- history of ACS (MI, unstable angina)
- stable IHD
- ischaemic stroke
- TIA (transient ischaemic attack)
- PAD (peripheral artery disease)
- AAA (abdominal aortic aneurysm)
- post-CABG (coronary artery bypass graft)
- post-PCI (percutaneous coronary intervention)
