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Cards Lipid Mgmt


Lipid screening: there is relationship between Total Chol & LDL and: Risk of CHD & coronary mortality
Lowering LDL in moderate / high risk patient leads to: Fewer CV events
Mgmt of Low HDL-C Wt reduction & increased physical activity; LDL-C is primary target of tx; Non-HDL-C is secondary target of tx (if trigs >200 mg/dL); consider nicotinic acid or fibrates
ATPIII chol screening for pt w/o CHD: LDL < 160 & 0-01 risk factor; or LDL <130 & >1 risk factor: rescreen in 5 yrs
ATPIII risk determination Step 1 1. Fasting lipid level
ATPIII risk determination Step 2 2. determine CHD equivalents
ATPIII risk determination Step 3 3. Major CHD factors other than LDL
ATPIII risk determination Step 4 4. If >1 non-LDL CHD factor (in pt w/o CHD or equivalent): use modified Framingham criteria
ATPIII risk determination Step 5 5. Detn risk category to establish LDL goal, when to initiate tx lifestyle changes, & when to consider drug tx
ATP III criteria: Metabolic syndrome Dx criteria 3 of 5: central obesity (waist men >40 in & women >35); trigs ≥150; HDL <40 (M) & <50 (F); BP ≥130/85; FPG ≥100 or Dx of DM
IDF metab syndrome definition Increased waist girth + any 2: Trigs >150; HDL <40 (M) & <50 (F); SBP >130, DBP >85, or HTN tx; FPG >100 or prior dx type 2 DM
CV risk factors in DM pts Type I: high trigs & HTN. Type 2: dyslipid, HTN, ins resistance, obesity, FH atherosclerosis; SMK NOT risk factor for I or 2
3 levels of prevention Primary: remove risk factors; secondary: early detection & tx; tertiary: reduce complications
A) fats that contribute to CV disease; B) fats that may be cardioprotective A. Saturated & trans fat. B. monounsaturated & polyunsaturated fat
Framingham: MI risk MI risk increases by 25 percent for every 5 mg/dL decrement in HDL below median values
Low HDL: risk factors SMK; sedentary;obese; insulin resistant/ DM; hypertriglyceridemia; chronic inflammatory dz
Cardioprotective HDL levels = >60 mg/dL (>75 assoc w/ longevity syndrome)
ATP III: normal triglyceride level = <150
ATP III: borderline high triglyceride level = 150-199
ATP III: high triglyceride level = 200-499
ATP III: very high triglyceride level = >500
Primary concern w/ ATPIII borderline high TGs: Metabolic syndrome
Primary concern w/ ATPIII High category CHD
Primary concern w/ ATPIII Very High category pancreatitis
ATP III recommends Chol screening how often? at least every 5 yrs for pts 20 or older
Pts w/ borderline-high chol & <2 risk factors should be rescreened: within 1-2 yrs
Framingham risk factors Age, TC, HDL, BP, & SMK
HLD: eye sxs xanthelasmas (sharply demarcated yellowish fat deposits around eyelids; arcus senilis; lipemia retinalis (if TG >2000)
4 primary RFs for atherosclerosis Smoking, hypertension, diabetes mellitus, hypercholesterolemia
ATP III: Hypertriglyceridemia >150 mg/dl
ATP III: Low HDL Cholesterol <40 mg/dl
ATP III: Optimal LDL = <100 mg/dl
ATP III: High LDL = >160 mg/dl
ATP III: Goal LDL for pts with 2 Risk Factors = <130 mg/dl (<160 for 1 RF)
ATP III: Goal LDL in high risk populations (CAD, DM) <100
Goal LDL in VERY high risk pts (10-yr risk of cardiac event 20%, recent MI, CAD+DM, CAD+smoking, CAD+metabolic syndrome) = <70
CAD RFs Smoking, HTN, low HDL (<40), FH early CHD (1st degree M<55 or F<65), Age (M>45, F>55)
ATP III: Desirable Total Cholesterol = <200
ATP III: Borderline High Total Cholesterol = 200-239
ATP III: High Total Cholesterol = >240
1stline tx for high triglycerides Fibrates (gemfibrozil / Lopid) [AE: rhabdo]
2ndline tx for high triglycerides Niacin (nicotinic acid) [AE: flushing] and omega-3 FAs
Tx for Dyslipidemia / high LDL 1stline: lifestyle modifications. 2nd: statins (HMG-CoA reductase inhibitors)
Bile acid sequestrants: MOA Work in the GI tract (not systemically absorbed); inhibit emulsification of triglycerides
Consistent predictor of DM, CHD, and mortality = Waist circumference (>TG, Chol, wt)
Metabolic syndrome is most prevalent in which ethnic group? Mexican American
One of the most sensitive predictors of CAD is this lab value = TC : HDL ratio
Niacin is associated with a reduction in: CAD
A primary dietary source of omega-6 FAs is: Flax seed
Primary concern (AE) in use of fibrates and statins is the potential for: Rhabdomyolysis
In a 54 yo male with metabolic syndrome, CAD, & current hx of smoking, what is the LDL goal? <70
In a 56 yo female with current hx of smoking, what is the LDL goal? <130
In a 42 yo male with no CAD risk factors, what is the LDL goal? <160
Created by: Adam Barnard Adam Barnard