Management Of Dyslipidemia

Front 1

what is Dyslipoproteinemia?

Back 1

- disorder of the lipid & lipoprotein transport pthwy assoc w/ arterial dx
- usually includes...
...hypercholesterolemia
...low HDL
...inc triglycerides

Front 2

Dyslipoproteinemia is a major risk factor for...?

Back 2

- atherosclerosis
- CHD

Front 3

what do we need cholesterol for? where is it made?

Back 3

- for cell mem, sex hormones, bile acids
- in the liver

Front 4

T/F cholesterol is a component of lipoproteins?

Back 4

T

Front 5

what sucks for you if you have familial hypercholesterolemia?

Back 5

- earlier atherosclerosis (20-30)
- leads to early MI (20s)

Front 6

Total cholesterol ranges?

Back 6

desirable =<200
borderline high = 200-239
high = >240

Front 7

LDL cholesterol ranges?

Back 7

desirable = <100
near optimal = 100-129
borderline high = 130-159
high = 160-189
very high = >190

Front 8

causes of elevated Triglycerides?

Back 8

- obese
- no exercise
- ciggs
- too much booze
- very high carb intake
- diseases (DM type 2, chronic renal failure, nephrotic syn)
- drugs (corticosteroids, protease inhibitors for HIV, beta-blockers, estrogen)
- genetic factors

Front 9

3 diseases that may predispose you to high triglycerides?

Back 9

1. DM type 2
2. chronic renal failure
3. nephrotic syndrome

Front 10

Drugs that may predispose you to high triglycerides?

Back 10

1. corticosteroids
2. HIV drugs (protease inhibitors)
3. Beta-blockers
4. estrgoen

Front 11

Triglyceride new ranges?

Back 11

normal = <150
borderline high = 150-199
high = 200-499
very high = >500

Front 12

T/F high triglycerides is indeed a CVD risk factor?

Back 12

punch yourself if you thought F

Front 13

Causes of low HDL?

Back 13

- obese
- no exercise
- ciggs
- very high carb intake
- ELEVATED TRIGLYCERIDES
- DM Type 2
- drugs ( Beta-blockers, anabolic steroids, progestational agents)
- genetic factors

Front 14

3 drugs that could cause a low HDL?

Back 14

1. Beta blockers
2. anabolic steroids
3. progestational agents

Front 15

low HDL is an independent predictor for what?

Back 15

- premature MI

Front 16

why do we want high HDL?

Back 16

b/c it has a protective effect by negating some of the negative risk factors for CHD

Front 17

HDL ranges?

Back 17

low (bad) = <40
high (good) = >60

Front 18

Which is a worse risk for developing CHD, high LDL w/ high HDL or low LDL w/ low HDL??

Back 18

- low LDL and low HDL is worse b/c dont have that protective effect of HDL

Front 19

what is the primary target for preventing CHD?

Back 19

lowering LDL

Front 20

What type of pts get primary prevention for CHD?

Back 20

- no sx.
- have risk factors though

Front 21

What type of pts need to receive secondary prevention for CHD?

Back 21

- if have known CHD problem
---->Ex. previous MI, angina, or + stress test
- if have CHD equivalent
----> Ex. DM, PAD (peripheral artery dx)
- if pt is determined to have a 10yr risk >20%

Front 22

when do you determine lipoprotein levels?

Back 22

after a 9-12 hour fast

Front 23

if LDL level exceeds TLC (therapy lifestyle change) goal what is the next step in tx?

Back 23

drug therapy to lower LDL

Front 24

T/F treat elevated triglycerides and then low HDL levels?

Back 24

T, b/c its easier to treat. currently we dont have any great drugs for raising HDL levels

Front 25

M or F more at risk for CHD?

Back 25

men

Front 26

3 nonmodifiable risk factors for CHD?

Back 26

1. inc age
2. male
3. family hx of premature CHD

Front 27

what is a negative (protective) risk factor for CHD?

Back 27

high HDL (>60 mg/dL)

Front 28

how would you tx a pt w/ multiple risk factors for CHD but normal LDL levels?

Back 28

primary prevention - TLC

Front 29

how would you tx a pt w/ low risk of CHD (10yr < 10%) w/ LDL levels borderline high (130-159) or below?

Back 29

primary prevention - TLC
*NO LDL lowering Drugs

Front 30

how would you tx a patient w/ low risk of CHD (10 yr < 10%) w/ high LDL levels (>160)?

Back 30

Primary prevention (TLC)
+ LDL lowering drugs

Front 31

how would you tx a person w/ multiple risk factors thus a higher risk of developing CHD (10 yr 10-20%)?

Back 31

drug therapy should only be considered if target LDL goal of <130 mg/dL cannot be acheived via TLC

Front 32

how tx pt with highest risk for CHD (10 yr >20 %) if LDL goal of <100 mg/dL cannot be met?

Back 32

drug therapy plus TLC

Front 33

what is the tx for pt w/ 0-1 risk factors of CHD w/ LDL >159?

Back 33

- drugs optional when levels are b/w 159-189
- drugs should be used if levels are >190

Front 34

what is the traget LDL goal for a person w/ low risk of CHD (0-1 risk factors)?

Back 34

<160 mg/dL

Front 35

when should you begin cholesterol testing?

Back 35

young adulthood (>20)

Front 36

when use drugs in young patient (20's)?

Back 36

LDL levels >190

Front 37

what is the LDL goal for persons w/ established CHD or diabetes?

Back 37

<100mg/dL
---need to tx pt w/ TLC + drugs if above this mark

Front 38

what 4 clinical forms of non-coronary atherosclerosis are equivalent to the risks of CHD?

Back 38

1. DM type 2
2. PAD
3. Carotid artery dx
4. abdominal aortic dissection
(they have the same LDL-C goal of <100mg/dL)

Front 39

what are the LDL-C goals for the following risk levels?
1. CHD/CHD equivalent
2. Multiple (2+) risk factors
3. 0-1 risk factors

Back 39

1. <100 mg/dL
2. <130 mg/dL
3. <160 mg/dL

Front 40

what are some examples of TLC?

Back 40

- cut down on the saturated fats & chol
- eat less red meat, dairy and more veggies
- weight reduction
- more exercise

Front 41

what tx for following scenarios...
LDL goal is <100 (meaning CHD/CHD equivalent risk) but actual LDL level is...
1. >130
2. 100-129
3. <100

Back 41

1. TLC + drug therapy
2. TLC & consider drug options
3. TLC only. NO drugs