Hyperlipidemia

Question 1

Primary Hyperlipidemia

Answer 1

-Familial causes
-Types I-V
Fredrickson Classification

Question 2

Secondary Hyperlipidemia

Answer 2

– Acquired
Due to other underlying cause
Modifiable risk factors
Medication use (beta blockers, thiazide diuretics, glucocorticoids, estrogen)

Question 3

Risk of CVD

Answer 3

Lifetime risk decreases to 5% with:
Recommended Physical Activity
Recommended Diet
No Smoking
LDL < 100 mg/dL
Fasting glucose < 100 mg/dL
SBP < 120 mmHg

-If one factor is not optimal risk increases to 30%

Question 4

Screening Recommendations

Answer 4

Start at age 18 (Lipids and Fasting glucose)
Screen every 5 years
(men > 35, women > 45)
Determine Framingham Score or ASCVD Risk Score
Additional screening in special circumstances
-Fast 9-12 hrs prior to draw

Question 5

Cholesterol

Answer 5

Desirable < 200 mg/dL
Borderline 200-239 mg/dL
High > 240 mg/dL

Question 6

Triglycerides

Answer 6

Desirable < 150 mg/dL
Borderline 150-199 mg/dL
High 200- 499 mg/dL
Very High > 500 mg/dL

Question 7

HDL (Good)

Answer 7

Low < 40

High > 60 mg/dL

Question 8

LDL (Bad)

Answer 8

Optimal < 100 mg/dL
Near optimal 100-129 mg/dl
Borderline 130-159 mg/dL
High 160-189 mg/dL
Very High > 190 mg/dL

Question 9

Hyperlipidemia risk factors

Answer 9

Age (+/-)
Gender (+/-)
Obesity
Abnormal fasting blood glucose (DM)
Tobacco use
Heavy Alcohol use
Elevated Systolic Blood Pressure

Question 10

Dyslipidemia

Answer 10

abnormal amounts of lipids in blood; most are hyperlipidemias

Question 11

Hypercholesterolemia

Answer 11

elevated cholesterol (LDL); >200 mg/dL

Question 12

Hypertriglyceridemia

Answer 12

elevated triglycerides; > 150 mg/dL

Question 13

Lipid Disorders

Answer 13

Hyperlipidemia: elevated lipid (fat) levels or lipoproteins in the blood

-Particles classified according to density

-Measures:
Cholesterol
Triglycerides
LDL
HDL
Non-HDL cholesterol

Question 14

HMG-CoA Reductase Inhibitors / statins

Answer 14

Atorvastatin (Lipitor)

Simvastatin (Zocor) – DO NOT USE 80 mg dose-can have more drug interactions

Pravastatin (Pravachol)

Rosuvastatin (Crestor)

Lovastatin (Mevacor)**

Fluvastatin (Lescol)

Question 15

2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 1

Answer 15

patients ≥21 years of age with clinical ASCVD

Question 16

2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 2

Answer 16

adults ≥21 years of age with LDL-C ≥190 mg/dl (not due to secondary modifiable causes)

Question 17

2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 3

Answer 17

adults aged 40-75 years without ASCVD, but with diabetes and with LDL-C 70-189 mg/dl

Question 18

2013 ACC/American Heart Association (AHA) cholesterol guideline-Risk group 4

Answer 18

adults aged 40-75 years without ASCVD or diabetes, with LDL-C 70-189 mg/dl, and an estimated 10-year risk for ASCVD of ≥7.5%, as determined by the Pooled Cohort Equations

Question 19

Statin Therapy: High-intensity statin

Answer 19

Atorvastatin 40-80 mg

Rosuvastatin 20-40 mg

Question 20

Statin Therapy: Moderate

Answer 20

Atorvastatin 10-20 mg
Rosuvastatin 5-10 mg
Simvastatin 20-40 mg
Pravastatin 40-80 mg
Lovastatin 40 mg
Fluvastatin XL 80 mg
Fluvastatin 40 mg bid

Question 21

Additional Agents

Answer 21

Ezetimibe (Zetia)– preferred 1st non-statin add on

Vytorin (Simvastatin + Ezetimibe)

Nicotinic Acid (Niacin)

Ubiquinone (Coenzyme Q 10)

Alcohol (red wine)

Question 22

PCSK9 Inhibitor (for additional LDL lowering if not at goal on statin therapy-use w/ statin drug

Answer 22

Evolocumab (Repatha) injections- 140 mg/ml injection every 2 weeks

Alirocumab (Praluent) injections- 75 mg/ml injection every 2 weeks

Very expensive
Prescribed by specialists

Question 23

Hypertriglyceridemia

Answer 23

Gemfibrozil(Lopid)

Fenofibrate (TriCor)

Omega-3 fatty acids/ Fish Oil/ Lovaza
-Treat all w/ triglyceride level >500 mg/dl to prevent acute pancreatitis

Question 24

Ongoing Monitoring

Answer 24

• Reassess fasting lipids in 6-8 weeks after starting treatment
• Obtain baseline LFTs before initiating statins
• Check baseline CK in risk patients
• Data does not support monitoring LFTs routinely
• Cautious use of Statins with Finofibrates (esp. Gemfibrozil)*
• Check Creatine Kinase (CK) if suspect statin- associated myopathy or rhabdomyolysis (rare)