Notes in dyslipidemia

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Published	09/08/2024	statin intolerance is when:1.Tried at least {{c1::two}} different statins 2.Including either {{c2::pravastatin}} or {{c2::rosuvastatin}} 3. At {{c3::l…
Published	09/08/2024	suggestions to prevent statin intolerance are to:•Mitigate {{c1::drug interactions}} •Drink {{c2::fluids}} •Potential role for {{c3::Coenzyme Q-10}}
Published	09/08/2024	PSCK9 inhibitors are administered as an {{c1::injectable}} via {{c2::subcutaneous}} tissue
Published	09/08/2024	{{c1::PSCK9}} causes degradation of the LDL receptor on hepatocytes so by inhibiting it, it reduces LDL
Published	09/08/2024	adverse effects of PSCK9 inhibitors are mostly only {{c1::injection site}} reactions
Published	09/08/2024	PSCK9 inhibitors can be used concurrently with statins without increased risk of {{c1::myopathy}}!•
Published	09/08/2024	PSCK9 Inhibitor used as monotherapy reduces LDL up to {{c1::70%}}
Published	09/08/2024	{{c1::PSCK9 Inhibitor}} is used as monotherapy for primary hyperlipidemia including heterozygous familial hypercholesterolemia or homozygous familial …
Published	09/08/2024	{{c1::PSCK9 Inhibitor}} is used as monotherapy to reduce the risk of MI/Stoke in patients with clinical ASCVD (especially if intolerant of statin…
Published	09/08/2024	{{c2::PSCK9 Inhibitor}} can be used as combo therapy with any of its monotherapy indications with {{c1::statins/ezetimibe}}
Published	09/08/2024	{{c2::evolocumab}} and {{c2::alirocumab}} are {{c1::PSCK9 Inhibitor }}
Published	09/08/2024	{{c1::evolocumab}} and {{c1::alirocumab}} benefits in studies:- 1.5% reduction in cardiovascular death, stroke, nonfatal MI - reduced LDL to…
Published	09/08/2024	Omega-3 Fatty Acids is composed of {{c1::eicosapentaenoic acid (EPA)}} and {{c2::docosahexaenoic acid (DHA)}}•
Published	09/08/2024	Omega-3 Fatty Acids are used to reduce {{c1::triglycerides}} as adjunctive treatment
Published	09/08/2024	Omega-3 Fatty Acids may increase {{c2::bleeding}} risks and can be used safely in {{c1::pregnancy}}
Published	09/08/2024	omega 3 fatty acids had no additional reduction in ASCVD when used in conjunction with statins, EXCEPT {{c1::Icosapent Ethyl }}
Published	09/08/2024	{{c1:: Cholestyramine}} or {{c1::colestipol}} are {{c2::Bile Acid Sequestrants}} (med class)
Published	09/08/2024	Cholestyramine and colestipol (Bile Acid Sequestrants) MOA: {{c1::positively}} charged {{c2::resins}} binds {{c1::negatively}} charged {{c2::fatt…
Published	09/08/2024	{{c1::Cholestyramine and colestipol (Bile Acid Sequestrants)}} lowers LDL by 12-25%, potentially useful in younger patients with statin myopathy …
Published	09/08/2024	{{c1::Bile Acid Sequestrants }} causes GI side effects, especially at higher doses and must be separated from other medications by 1 hour be…
Published	09/08/2024	{{c1::Niacin}} inhibits {{c4::lipolysis}} of triglycerides by hormone sensitive {{c3::lipase}} which reduces transport of {{c2::fr…
Published	09/08/2024	{{c1::Niacin}} requires large (2-6 g/day) doses to see effect and is limited by adverse reactions: flushing, dyspepsia, hepatotoxicity, hyperglyc…
Published	09/08/2024	{{c1::niacin}} has no additional benefit in reduction of ASCVD; therefore, FDA removed indication for use in statin therapy, no longer recommended in …
Published	09/08/2024	{{c1::Evinacumab}} is a monoclonal antibody against {{c2::angiopoetin-like 3 }}
Published	09/08/2024	{{c1::Evinacumab}} is approved as adjunct therapy with other LDL medications for patients 12 and older for homozygous familial hypercholesterolemia AN…
Published	09/08/2024	{{c1::Evinacumab}} are created to target patients who have genetic alterations that cause an absence of LDL receptor expression
Published	09/08/2024	{{c1::Lomitapide}} inhibits microsomal triglyceride transfer protein and reduces transfer of chylomicrons and VLDL to blood stream
Published	09/08/2024	{{c1::Lomitapide}} is indicated for reduction in LDL, TC, apo B in patients with homozygous familial hypercholesterolemia
Published	09/08/2024	{{c1::Lomitapide}} reduced LDL up to 50% when used with max tolerated statin and has concerns with causing serious {{c2::hepatotoxicity}} and&nbs…
Published	09/08/2024	{{c1::Mipomersen}} inhibits translation of mRNA for Apo-B 100 and is only indicated for homozygous familial hypercholesterolemia. The REMS progra…
Published	09/08/2024	statin benefit groups tht receive {{c1::secondary}} prevention are {{c2::GROUP 1}}: individuals with clinical atherosclerotic cardiovascular dise…
Published	09/08/2024	statin benefit groups tht receive {{c1::primary}} prevention are individuals WITHOUT clinical ASCVD and have one of the following crite…
Published	09/08/2024	ASCVD Risk Calculator looks at specific factors to determine {{c1::10}} year risk of developing cardiovascular disease/event and is not valid in …
Published	09/08/2024	If you are healthy and without diabetes, the {{c1::Reynolds Risk Score}} is designed to predict your risk of having a future heart attack, s…
Published	09/08/2024	In addition to your age, blood pressure, cholesterol levels and whether you currently smoke, the {{c1::Reynolds Risk Score}} uses information from two…
Published	09/08/2024	the information required to estimate ASCVD risk for the {{c1::Framingham}} Risk Score study includes age, sex, race, total cholesterol, HDL cholestero…
Published	09/08/2024	for primary prevention therapy for statin benefit group {{c1::2}} (individuals with LDL ≥ 190 mg/dL) start {{c2::high}} intensity statin.
Published	09/08/2024	for primary prevention therapy for statin benefit group {{c3::3}} (DM and age 40-75 years), start {{c1::moderate to high}} intensity statin …
Published	09/08/2024	for primary prevention therapy for statin benefit group {{c1::4}} (No DM, Age 40-75 years, ASCVD Score >7.5%), start {{c2::moderate}} int…
Published	09/08/2024	for people who have an ASCVD Risk Score < 7.5% and are less than 40 years old, have a discussion between {{c1::risk}} of statin therapy and {{…
Published	09/08/2024	{{c1::Mediterranean}} Diet and {{c1::plant based}} diets have been studied and validated to decrease cardiovascular disease and should …
Published	09/08/2024	non-pharm therapy recommendations for primary prevention for dyslipidemia are: {{c1::Exercise}}, {{c1::Risk Factor}} Modifications and&…
Published	09/08/2024	Primary prevention goals of therapy are:•reduce LDL to < {{c1::130}} mg/dL and select patients to < {{c2::100}} mg/dL •Limit progression to {{c3…
Published	09/08/2024	Secondary Prevention for statin groups is differentiate into very high risk or not.It is defined as having the following:•Recent ACS within 12 months …
Published	09/08/2024	very high risk groups that need secondary prevention must receive {{c1::high}} intensity statins which has been validated in multiple clinical trials …
Published	09/08/2024	What about patients who already are on high intensity statin/max tolerated statin at time of new event and are classified as high risk group for secon…
Published	09/08/2024	for people who need secondary prevention and are not considered very high risk and are older than 75 years old, maximum benefits of therapy are n…
Published	09/08/2024	for people who need secondary prevention and are not considered very high risk and are older than 75 years old, if they are not al…
Published	09/08/2024	for people who need secondary prevention and are not considered very high risk and are younger than 75 years old, it is a goal to reduc…
Published	09/08/2024	Secondary Prevention Goals of Therapy are to:•Reduce LDL to {{c1::< 100}}mg/dL and in select patients to {{c2::< 70}} mg/dL •Limi…
Published	09/08/2024	Hypertriglyceridemia Treatment:•In patients > 20 years of age with triglycerides 175 – 499 mg/dL → {{c1::Lifestyle}} modifications, address {{c1::o…
Published	09/08/2024	{{c1::PCSK9 inhibitors}} can cause injection site reactions, masopharyngitis, rhinorrhea, and flu like symptoms
Published	09/08/2024	lipoproteins are made up of a {{c1::hydrophobic}} core and surrounded by {{c1::hydrophilic}} lipids and proteins. The surrounding proteins are called …
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Published	09/08/2024	statins are {{c1::HMG-CoA reductase}} inhibitors
Published	09/08/2024	statins inhibit {{c1::conversion}} early in {{c2::cholesterol}} synthesis. They competively inhibit {{c3::HMG-CoA}}.
Published	09/08/2024	Statins increase expression of LDL {{c1::receptor gene}} which makes the liver more able to {{c2::metabolize}} LDL so statins mostly work on LDL {{c3:…
Published	09/08/2024	high intensity statins are {{c1::atorvastatin}} (40-80mg) and {{c2::rosuvastatin}} (20-40mg) and lower LDL by >{{c3::50}}%
Published	09/08/2024	moderate intensity statins lower LDL by {{c1::30-50}}% on initiation
Published	09/08/2024	low intensity statins lower LDL-C by <{{c1::30}}%
Published	09/08/2024	Testing for transient {{c2::hepatotoxicity}} is {{c1::not recommended}} for routine clinical screening unless clinical symptoms are suggesetive of {{c…
Published	09/08/2024	statins are contraindicated in {{c1::pregnancy}}
Published	09/08/2024	{{c1::myalgias}} and {{c1::myopathy}} are the most common adverse reactions of {{c2::statins}} and range from soreness and weakness to rhadomyolysis&n…
Published	09/08/2024	Rhabdomyolysis (often called rhabdo) is a serious medical condition that can be fatal or result in permanent disability. Rhabdo occurs when damag…
Published	09/08/2024	Risk for muscle adverse effects increases in {{c1::proportion}} with statin dose
Published	09/08/2024	Risks of statins increase in patients older than {{c2::80}} years of age, {{c1::hepatic}} or {{c1::renal}} dysfunction, {{c3::perioperative}} periods,…
Published	09/08/2024	Check {{c1::creatinine kinase}} if suspecting rhabdomyolysis and a patient clinically correlates while taking statins
Published	09/08/2024	Statins are extensively metabolized by {{c1::CYP3A4}}. Because of this, other medications that inhibit {{c1::CYP3A4}} metabolism increase risk for sta…
Published	09/08/2024	Gemfibrozil, digoxin, macrolides, azoles, HIV protease inhibitors, amiodarone can increase risk of {{c1::statin myopathy}} because they are CYP3A4 inh…
Published	09/08/2024	{{c3::Pravastatin}}, {{c2::fluvastatin}} and {{c1::rosuvastatin}} are not extensively metabolized by CYP3A4 and are less likely to cause myopathy
Published	09/08/2024	So if statin myopathy and intolerances are a problem, can I start a low dose and titrate up to avoid those problems? {{c1::NO}}
Published	09/08/2024	the most benefit you get from a statin is when {{c1::you start it}}
Published	09/08/2024	RULE OF 7 FOR STATINS says that every doubliing of statin dose ONLY reduces LDL by an additional {{c1::7}}%
Published	09/08/2024	{{c1::Bempedoic Acid (Nexletol)}} are non-statin, statin drug. It inhibits {{c2::ATP-citrate lyase}}.
Published	09/08/2024	{{c1::Bempedoic Acid (Nexletol)}} has no statin-like myopathy
Published	09/08/2024	Bempedoic Acid (Nexletol) is associated with hyper{{c1::uricemia}} and {{c2::gout}} symptoms
Published	09/08/2024	there is no data that shows {{c1::Bempedoic Acid (Nexletol) }} decreases cardiovascular events but it does lower LDL
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Published	09/08/2024	{{c1::Fibric Acid Derivatives (Fibrates)}} are thought to be mediated through PPARα but MOA is truly unknown
Published	09/08/2024	Fibrates decrease serum {{c1::triglycerides}} and has a moderate effect on increasing serum {{c1::HDL}}
Published	09/08/2024	fibrates are metabolized extensively via {{c1::liver}}, conjugates excreted via {{c2::kidneys}}. It requires dose reduction by {{c4::50%}} if GFR {{c3…
Published	09/08/2024	{{c1::Gemfibrozil}}and {{c2::Fenofibric acid }} are {{c3::fibrates }}
Published	09/08/2024	fibrates are used for {{c1::hypertriglyceridemia}} (always correct to treat if > 500 mg/dL)•
Published	09/08/2024	Side effects of fibrates are: •{{c1::Minimal}} if monotherapy, main side effect related to {{c2::GI}} •Increased risk of {{c3::myopathy…
Published	09/08/2024	{{c1::Ezetimibe}} is an inhibitor of {{c2::cholesterol}} absorption
Published	09/08/2024	{{c3::ezetimibe}} reduces {{c1::luminal cholesterol}} uptake via inhibition of transport protein {{c2::NPC1L1}} which reduced cholesterol ab…
Published	09/08/2024	Ezetimibe is NOT to be used as {{c1::monotherapy}}
Published	09/08/2024	ezetimibe shows benefit only when used with a {{c1::statin}}
Published	09/08/2024	{{c2::ezetimibe}} may not work as well if patient already does not eat a lot of {{c1::fatty foods}}
Published	09/08/2024	the {{c1::REDUCE-IT}} trial showed that {{c2::icosapent ethyl}} (omega 3 fatty acid) had a 4.8% reduction in composite of CV death, nonfatal MI, strok…
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