chapter 30 hyperlipidemia

Question 1

treatment for hyperlipidemia

Answer 1

• lifestyle modifications

- statins, fibrates, bile acid sequestrants, niacin, ezetimimbe, vitamins/CAM

Question 2

vitamins and CAM for hyperlipidemia

Answer 2

• omega 3 fatty acids: treats very high triglycerides, but does little for HDL or lowering LDL (may actually increase)
• red yeast rice-mimics statins
• beta carotene
• vitamin E
• folic acid
• herbs
• vitamin C
• selenium

Question 3

children and adolescents

Answer 3

• small amount have genetic disorders-when do, total cholesterol is 1.5-3x of normal
• optimal cholesterol levels: total

Question 4

risk evaluation for CHD

Answer 4

• therapy changes according the risk factors present
• high risk: pts with clinical evidence of CHD at higher risk for another MI event; decrease risk by lowering lipids; pts with metabolic syndrome at high risk; diabetes pt at higher risk for mortality from MI
• moderate risk: 2 or more risk factors but no clinical evidence of CHD; intensity of therapy dependent on 10 year risk and LDL level
• low risk: 0-1 risk factor, pt with LDL60, fasting triglyceride 150-200 mg

Question 5

middle age men

Answer 5

• higher risk of CHD
• combination of statin with bile acid-binding resin very effective to lower LDL
• high prevalence of metabolic syndrome
• factors favoring drug tx: higher age, obesity, cigarette smoking, positive family hx, very low HDL

Question 6

women

Answer 6

• before the age of 45 lower risk for CHD than men
• control of risk factors: antihypertensives and beta blockers, ASA for those at high risk
• HRT no recommended for LDL lowering

Question 7

older adults

Answer 7

• higher prevalence of DM in this population
• emphasis on dietary changes with drug tx
• higher risk for muscle toxicity if statins given with macrolides
• higher risk for polypharmacy problems
• thiazide diuretics assoc. with increasing hyperlipidemia

Question 8

young adults

Answer 8

• nicotinic acid and fibric acid derivatives are pregnancy class C
• statins pregnancy class X
• pregnant women are better treated with life style modification-may be treated with bile acid-binding drugs
• all anti-hypertensives avoided during breast feeding
• CHD rare in this group-but if develop treat aggressively to lower LDL
• higher risk of CHD if DM one or heavy smoker

Question 9

treatment points

Answer 9

• focus on LDL first especially with men
• HDL is not protective if LDL high
• triglycerides will reduce somewhat if LDL reduces-treat LDL first

Question 10

triglycerides

Answer 10

• heavily linked with sugar intake and trans fatty acids

- omega-3 and fiber are mainstays for care