Hyperlipidemia

Question 1

primary prevention; LDL more than 190 at any age

Answer 1

start high density statin right away

Question 2

primary prevention; LDL less than 190, age 40-75 with diabetes

Answer 2

moderate to high-intensity statin depending on ASCVD risk score

Question 3

primary prevention; LDL less than 190, age 40-75 with no diabetes

Answer 3

calculate the ASCVD risk score
7.5-20% — moderate intensity statin
more than 20 % —- high-intensity statin

Question 4

for secondary prevention ( patient with known vascular occlusive disease); age less than 75

Answer 4

high-intensity statin

Question 5

for secondary prevention, age more than 75

Answer 5

moderate to high intensity statin

Question 6

per USPSTF – for primary prevention with 1 ASCVD risk factor

Answer 6

threshold for starting statin is 10%

Question 7

For LIPID screening; AHA /ACC

Answer 7

age 21-75 every 4-6 years. earlier if strong family history

Question 8

For lipid screening; USPSTF

Answer 8

age 40-75 every 5 years

Question 9

secondary causes of hyperlipidemia

Answer 9

hypothyroidism, uncontrolled diabetes, excessive alcohol use, smoking, obstructive liver disease, nephrotic syndrome, chronic kidney disease, and certain medications (e.g., thiazides, beta-blockers, glucocorticoids).

Question 10

what to check if patient develops myalgias on statin

Answer 10

check for hypothyroidism, vitamin-D deficiency. check CK and BMP.

Question 11

if statins fail?

Answer 11

Consider ezetimibe and/or a PCSK9 inhibitor if strong indication