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Dislipidemia
| Question | Answer |
|---|---|
| overall goal of treatment | to prevent AVD according to ATP III: primary target is to attain LDL goal |
| secondary goal | attain non-hdl goal and only applies if primary target has been achieved and if tg are 200-400 |
| tertiary target | raise HDL only applies in pts with metabolic syndrome only if HDL <40 in men or <50 in women after attaining non hdl goal secondary targets must be achieved |
| exception | if TG are very high > 500 reduce TG to < 500 first then focus on primary |
| assess patient specific cv risk determin targets evaluate lifestyle habits rule out secondary dyslipidemia | |
| RISK | >20% fram risk score is very high risk >10% is moderately high risk with 2 or more CV risk factors and 10yr risk of 10-20 moderate risk is 2 or more rf and 10 yr risk <10% lower risk is 0-1 rf |
| patients with 0-1 rf and no avd 10 yr risk of CHD is likely <10% | framingham risk is not needed and not recommended |
| NCEP ATPIII Major RIsk Factors that midify LDL goal exclusive of LDL | Cigarette smoking 5+ cigs per day htn >140/90 or on antihypertensive med low hdl <40 family history of premature CHD: 1st degree male <55 CHD female 1st degree <65 age in men >45 and women >55 |
| negative risk factor | HIgh HDL >60 is a negative risk factor that removes 1 risk |
| moderately high and moderate risk patients | 2 or more risk factors and no AVD based on calculated 10 year CHD score mod<10% mod high 10-20 high risk >20% and considered CHD risk equivalent |
| NCEP ATP III RISK FACTORS 5 of them | cig smoking more than 5 per day hypertension low hdl less than 40 family history of male with chd before 55 and female before 65 |
| HMG Coa Reductase inhib aka STATINS | first line therapy for most patients most effective in LDL lowering outcomes data show definitevely reduced CV events and mortality in multiple patient populations |
| side effects of statins | gi upset, headache infrequent bu possible hepatotoxicity rare but requires monitoring muscle related side effects |
| Myopothy in pts on statins | complaints of myalgia weakness and or cramps plus an elevation in serum creatnine kinase > 10 the upper limit of normal this is released with muscle breakdown rhabdomyolysis abnormal renal function CK>10000 or CK> 10 plus an elevation in scr or medical |
| common secondary causes | fd |
| atorvastatin (lipitor) | 10, 20, 40 start/day usual range is 10-80/day |
| fluvastatin (lescol) | 20 or 40 up to 40 |
| slow release fluvastatin (lescol XL) | 80 |
| lovastatin Mevacor | 20 start range 10-80 |
| pravastatin (pravachol) | start 40range 10-80 |
| ext release lovastatin (altoprev) | start 20, 40, 60 range 10-60 |
| rosuvastatin (crestor) | start 10, range 5-40 |
| simvistatin (ZOcor) | start 20 or 40 range is 5-80 |
Created by:
Jamiecappello
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