Lipid update Flashcards
(25 cards)
Is there any advantage in giving thiazide diuretic to someone with a beta blockers with a BP of 140/80?
Yes - add thiazide diuretic intensively to reduce to 120/80
Intensive management of blood pressure
Intensive lifestyle modification
Aspirin
High dose statin
Optimal blood pressure
Example of statin and its dose
Atorvastatin 40-80mg od
What do you call it when patients are given a statin and told they might get muscle pain and they do actually get muscle pain?
nocibec event
What is PCSK9?
It controls the rate of LDL receptor
What is PCSK9?
It controls the rate of LDL receptor by breaking it down
Give an example of a PCSK9 inhibitor? What does it do?
Evolocumab - stops the breakdown of LDL receptor
How effective was adding PCSK9 in lowering LDL levels?
Reduces MI chance, but doesn’t reduce the chance of death
Compare adding PCSK9 to statin with adding thiazide to BB
PCSK9 was marketed for those with statin intolerance
Problem is that it is SO EXPENSIVE compared to thiazide
How long does it take to have good blood glucose control?
15 years
What is the legacy effect?
If you have tight control when you have patent coronary arteries, the benefits persist even if you then become less well control. Basically good control early on in your disease is excellent. The benefits exist for at least 30 years.
UKPDS study - intensive T2DM therapy findings
20 years intervention
Further 10 ears follow-up showed that the study group benefited even after the study was over
What happened when Rosiglitazone was given to patients? What was the study called and who was it done by and done on?
Tight blood glucose control in later stages of life caused more death. It has been banned.
Thiazolidinedione
ACCORD study done by pharma companies - they took patietns who had already had 1 vascular event.
After this,
The first trial
DCCT - diabetes control and complications trial
Good control improves everything
How does SGLT 2 inhibitors work
GLYCOSURIC DRUG
They make you pee our glucose as they stop glucose reabsorption in the PCT
You loose BP as it is a diuretic
and you loose weight because you’re losing
What does MACE mean?
Major adverse cardiac events
Name an SGLT2 inhib and its effectiveness
Empaglifozin - the cardiovascular death risk reduces within six months!
What was the study on SGLT2 inhibitors called?
EMPA-REG study
What is the one side effect of SGLT2 inhibitors?
More likely to get UTI
Empaglifozin effects on kidneys
Risk of nephropathy, need for dialysis and doubling serum-creatine dropped
What do you see in terms of effects of empaglifozin?
Initially it makes your eGFR worse but as you persist, it has a renoprotective effect (like with ACE-inhibitors)
Overall, what is the effect of empaglifozin?
Reduces blood sugars
Reduces CV risk
Reduces renal risk
Name a GLP-1 analogue
Liraglutide
What’s the problem with GLP-1 analogues?
they are a peptide so need to be taken
