straight memorization
optimal lab value for cholesterol
<200mg/dl
what are the alternative options for patients that do not tolerate statin therapy well? (x4, will accept 2/4)
ezetimibe
bempedoic acid
PSCK9 inhibitor
bile sequestrant
is this patient VERY high risk for ASCVD?
symptomatic peripheral artery disease, age 65, LDL of 90
NO. they have 1 major event but need 2+ high risk cxs. ABOVE 65 is high risk. LDL 100+ is high risk.
1 major event is NOT VERY high risk
LDL is directly measured as a component of the lipid panel
FALSE
it is indirectly measured from an equation, HDL - (TG/5) = LDL
when asking if a pt has ASCVD what are you looking for as major ASCVD events? x4
1. recent ACS (last 12 mo)
2. MI hx
3. hx ischemic stroke
4. symptomatic PAD (claudication, ABI <0.85, hx revascularization or amputation, aortic aneurysm)
optimal LDL and HDL levels in a female patient
LDL <100 mg/dl
HDL > 50 mg/dl
what kind of medication is rosuvastatin
high intensity LDL reduction >50%
75 year old pt with DM and hx of menopause prior to age 40 presents with LDL of 60 mg/dl. What are the next steps, if any?
regardless of LDL (despite below 70-189 threshold), we will start them on AT LEAST a moderate intensity statin. they do have a risk enhancing factor (menopause under 40) so i would accept a higher intensity statin maybe
fish oil supplements are no longer recommended due to lack of evidence
true
very high levels of triglycerides can lead to
pancreatitis
what is the difference between secondary and primary prevention
secondary they already have the disease, trying to prevent it from happening again
primary = don’t have disease, trying to prevent it
side effects of statins (x4)
myalgia
muscle cramps
rhabdomyolysis
diabetes
patient returns in follow up for secondary prevention of ASCVD. They are currently taking a high intensity statin and ezetimibe. Their most recent lab results show LDL level of 75. What are the next steps if any?
LDL goal is not below 70, continue all medications and add PCSK9 and follow up again in 4-12 weeks
statins are a powerful drug that reduce LDL levels and do not affect plaque stability
FALSE
they stabilize plaques and serve as anti-inflammatories
which of the following is an example of a risk enhancing factor of ASCVD that is NOT part of the ASCVD risk calculator?
1. ABI 1.4
2. menopause at age 45
3. chronic inflammatory disease
4. age
chronic inflammatory disease.
1 and 3 are close, ABI < 0.9 is a risk enhancing factor and menopause prior to age 40 is as well
LDL goal for a patient that is VERY HIGH RISK in secondary ASCVD prevention
LDL < 70 mg/dl
Bonus info: achieve w/ high intensity statin +/- ezetimibe +/- PCSK9 inhibitors (stepwise additions)
possible side effects of bempedoic acid
gout
gallstones
inc.d creatinine
inc.d uric acid
inc.d hepatic enzymes
a 65 year old male with LDL of 180. risk calculator is used which shows 10-year ASCVD risk of 23%. What are the next steps, if any?
pt is in mid age range with high LDL (70-189 mg/dl range) and 20+% risk = start HIGH INTENSITY STATIN
children should be screened with a lipid panel starting at age 9
kind of controversial.. CAN do it 9-11 and 17-19.. so true kind of
if we are worried about hypercholesterolemia we can screen between age 1-8
#1 cause of death in the world
ischemic heart disease
what is considered intermediate 10-year ASCVD risk for lipid management?
7.5%-19.9%
for primary prevention of cardiovascular disease in pts 49-59 years old, we may consider which medication if they have a 10+% risk of ASCVD with risk calculator?
daily low dose aspirin if pt is not at inc.d risk of bleeding
43 year old african american F returns for lab work f/u. Non-smoker, no hx of DM or ASCVD. LDL is 172, total cholesterol 232, HDL 43. Risk caclulator shows 1.2% risk. what are the next steps, if any?
age 40-7 w/ LDL 70-189 is what leads us to use the risk calculator. it was below 5% so we recommend lifestyle changes.
FALSE
not approved in children!! but statins are
what are the “bad” cholesterols?
non-HDL
VLDL, IDL, LDL (ldl is main culprit for atherosclerosis)