The density of plasma lipoproteins is determined by their relative content of which 2 things?
- Carries most of the triglyceride
- Carries 60 - 70% of total serum cholesterol
- % of HDL?
- % of VLDL?
HDL: 20 - 30%
VLDL: 10 - 15%
- In what organ is cholesterol made in?
- How many steps involved in production?
- Made from what?
- Acetyl CoA (breadown product of FFA)
Is cholesterol synthesized by the liver during morning or night time?
Predominantly at night
What substance is associated w/ the rate limiting step in synthesis of cholesterol by the liver?
- HMG-CoA reductase converts HMG-CoA to ____ during the rate limiting step.
- What is controlled during this step?
- Negative feedback is controlled (high levels of LDL)
- What type of drug is an HMG-CoA reductase?
- What can happen if dosage is too high?
Statin. * IF we lower cholesterol too much, if can affect our sex hormones.
Why do we treat dyslipidemia?? What are the 2 major associated complications of dyslipidemia?
Acute pancreatits (due to hyperlipidemia)
Atherosclerosis leading to ASCVD (leading cause of death for both genders)
What are the 5 risk factors of Dyslipidemia?
F: Family hx of premature CHD of 1st degree family (Men <55 & Women <65)
L: Low HDL cholesterol (<40), if >60 counts as neg risk factor
A: Age (Men >45 & Women >55)
S: Cigarette Smoking
H: HTN leading to CKD
What is a major secondary cause of lipoprotein abnormalities?
DRUGS (Rx drugs)
Tx of Dyslipidemia
- There is no RCT evidence to support what?
- There is extensive evidence for what?
- No evidence to support titrating cholesterol lowering drug therapy to achieve target LDL/non-HDL
Appropriate intensity of statin to reduce ASCVD
- Moderate intensity statin reduce LDL by what %?
- High intensity statin reduce LDL by what %?
Moderate: 30 - 50%
High: 50% or greater
What are names of "Non-Statin Therapies" recommended by 2017 ACC?
- Alirocumab and Evolocumab
- Patients w/ high risk for ASCVD (risk = 7.5 or 10%) should receive Statin therapy for which type of prevention?
- Patients w/ known ASCVD should receive Statin therapy for which type of prevention?
- Primary Prevention
- Secondary Prevention
Which 3 meds SHOULD NOT be routinely prescribed for primary or secondary prevention of ASCVD bc/ although they lower cholesterol, they don't alter pt oriented outcomes?
- Omega 3 fatty acids
What medication should be considered as an alternative for patients w/ acute coronary syndrome (ACS) who do not tolerate high intensity statin therapy?
Moderate Intensity Statin PLUS Ezetimibe
In all individuals, what should you emphasize?
Heart-healthy lifestyle across the life course
In patients w/ clinical ASCVD, reduce LDL cholesterol w/ what med?
High intensity statin
In patients with very high risk ASCVD, use an LDL threshold of ___mg/dL to consider addition of what med to pre-existing statin therapy?
- In patients with severe primary hypercholesterolemia (LDL > ____ mg/dL) WITHOUT calculating 10 yr risk, begin what med?
- If LDL remained >100, what should you add?
- If LDL on both of these meds is still >100, add what next?
- High intensity statin therapy
- PCSK9 inhibitor
In patients 40 - 75 yrs w/ DM and LDL > ___mg/dL, what med do you start?
Moderate intensity statin therapy WITHOUT calculating 10 yr risk
In adults 40 - 75 yrs evaluated for primary ASCVD prevention, give what med?
None yet, first have clinician / patient risk discussion before starting statin therapy
In adults 40 - 75 yrs without DM and LDL >___mg/dL, with a 10 yr risk >7.5%, what med do you start?
- Moderate intensity statin
In adults 40 - 75 yrs without DM and 10 yr risk of 7.5 - 19.9%, what med?
In adults 40 - 75 yrs without DM and LDL levels >___mg/dL to ___mg/dL, w/ a 10 yr risk of >7.5% to 19.9%, if decision about statin therapy is uncertain, consider measuring what?
- 70 to 189
Assess adherence and percentage response to LDL lowering meds and lifestyle changes w/ repeat lipid measurement ___ weeks after statin initiation or dose adjustment.
4 to 12 weeks
- "Low risk"
- Emphasize lifestyle changes to reduce risk
Risk 5 - <7.5%