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Cards Lipid Mgmt
Cardiology
| Question | Answer |
|---|---|
| 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): decreases serum apolipoprotein B-100; AE: flushing. Omega-3 fatty acids |
| 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. Cholestyramine (Questran), colestipol, colesevelam |
| 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:
Abarnard
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