HYPERLIPIDEMIA

Question 1

Q: What is hyperlipidemia?

Answer 1

A: A condition where there are elevated levels of lipids (cholesterol, triglycerides, or both) in the blood and low HDL
TG(increase risk to BV and tissue deposition)
low HDL(they remove fat/cholestrol from tissues)
high LDL (deposits of TC + TG on BV cuz atherosclertic plaques

Question 2

Q: What lipoproteins are involved in atherosclerosis?

Answer 2

A:
LDL-C (Low-Density Lipoprotein) – major contributor to plaque
VLDL & Triglycerides – also atherogenic
HDL-C (High-Density Lipoprotein) – protective (removes cholesterol)

Question 3

Q: Why is high LDL dangerous?

Answer 3

A: LDL particles deposit cholesterol in arteries → atherosclerotic plaque → ↑ risk of MI, stroke, PAD

Question 4

Statins (HMG-CoA Reductase Inhibitors)
Q: MOA?
Q: Indications?

Answer 4

A: Inhibit HMG-CoA reductase → ↓ cholesterol synthesis → ↑ LDL receptors → ↓ LDL
increase synthesis of HDL

First-line for high LDL, ASCVD prevention, post-MI/stroke
Diabetes patients age >40 with risk factors

Question 5

STATINS
Q: Monitoring?
Q: Counseling Points?

Answer 5

LFTs (AST, ALT) every 6 months
Lipid profile after 4–12 weeks
Watch for myopathy → monitor CK(creatinin kinase) if muscle pain=rhabdomyolysis

Question 6

Ezetimibe (Cholesterol Absorption Inhibitor)
Q: MOA?
Q: Indication?

Answer 6

A: Inhibits cholesterol absorption at intestinal brush border

Add-on to statin if LDL target not met
Used in statin-intolerant patients

Question 7

Ezetimibe
Q: Monitoring?
Q: Counseling?

Answer 7

Lipid profile
Liver enzymes if used with statins

Question 8

Fibrates (e.g., fenofibrate, gemfibrozil)
Q: MOA?

Q: Indications?

Answer 8

A: Activate PPAR-alpha → ↑ lipolysis → ↓ triglycerides, ↑ HDL

Severe hypertriglyceridemia (>5.6 mmol/L or >500 mg/dL)
Prevention of pancreatitis

Question 9

Fibrates
Q: Monitoring?

Q: Counseling?

Answer 9

a.Triglycerides
Liver and renal function
Risk of rhabdomyolysis with statins

b.Take with meals
Avoid combination with statins unless necessary
Watch for muscle pain

Question 10

Niacin (Vitamin B3)
Q: MOA?
Q: Indications?

Answer 10

A: ↓ hepatic VLDL synthesis → ↓ LDL and triglycerides, ↑ HDL

B.Used in mixed dyslipidemia
No longer first-line due to side effects

Question 11

NIACIN
Q: Side Effects?
Q: Counseling?

Answer 11

A.Flushing, hepatotoxicity, hyperglycemia, hyperuricemia
B.Take aspirin 30 min before to reduce flushing
Take with food
Monitor for blood sugar and uric acid

Question 12

Bile Acid Sequestrants (e.g., cholestyramine)
Q: MOA?
Q: Indications?
Q: Side Effects?
Q: Counseling?

Answer 12

A: Bind bile acids in intestine → excreted → liver uses cholesterol to make more
B.Adjunct for high LDL
May help in pruritus due to bile acid excess
Cholestsis of pregnancy
C.GI issues: constipation, bloating
May reduce absorption of fat-soluble vitamins (A, D, E, K)
D.Take other meds 1 hour before or 4–6 hours after ie digoxin
Mix with plenty of water

Question 13

PCSK9 Inhibitors (e.g., alirocumab, evolocumab)
Q: MOA?
Q: Indications?
Q: Monitoring?
Q: Counseling?

Answer 13

A: Monoclonal antibodies block PCSK9 → ↑ LDL receptors → ↓ LDL

B.Familial hypercholesterolemia
ASCVD not controlled on statins

C.Lipid panel
Injection site reactions

D.Administer via subcutaneous injection
Store in fridge
Expensive

Question 14

Targets & Monitoring Goals (2024 AHA/ESC)

Answer 14

Risk Category LDL Goal
Low Risk < 3.0 mmol/L
Moderate Risk < 2.6 mmol/L
High Risk (e.g. DM, CKD) < 1.8 mmol/L
Very High Risk (ASCVD) < 1.4 mmol/L (or <1.0 in some)

Question 15

Additional Counseling Tips for All Patients

Answer 15

Combine with lifestyle: diet, exercise, smoking cessation
Emphasize adherence – lipid control = lifelong
Encourage regular lipid checks
Be cautious with polypharmacy (especially in elderly)

Question 16

ASCVD 10 year risk ie stroke,MI

Answer 16

SAD CHF
Smoking
Age greater than 45M,55F
Daibetes
High TC
HTN
Family Hx

Question 17

Indication for statin therapy

Answer 17

1.ASCVD(CAD,CVA,PAD) less than 7.5-moderate statin else high intensity
2.LDL greater than 190
3.LDL greater than 70 =40-75yr =DM
4.ASCVD greater than 7.5 = 40-75yr = ldl greater than 70