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Cardiology

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