Podcast
Questions and Answers
What is the primary goal for patients with dyslipidemia in managing ASCVD risk?
What is the primary goal for patients with dyslipidemia in managing ASCVD risk?
Which of the following social determinants of health can most impact a patient's ability to manage ASCVD risk factors?
Which of the following social determinants of health can most impact a patient's ability to manage ASCVD risk factors?
Which statement accurately reflects a misconception regarding ASCVD and dyslipidemia?
Which statement accurately reflects a misconception regarding ASCVD and dyslipidemia?
Which combination correctly identifies a risk factor for secondary prevention of ASCVD?
Which combination correctly identifies a risk factor for secondary prevention of ASCVD?
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What is a critical factor in the diagnosis and management of familial dyslipidemias?
What is a critical factor in the diagnosis and management of familial dyslipidemias?
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Which factor is most likely NOT considered a risk factor for dyslipidemia and atherosclerotic cardiovascular disease (ASCVD)?
Which factor is most likely NOT considered a risk factor for dyslipidemia and atherosclerotic cardiovascular disease (ASCVD)?
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What is the primary mechanism of action for statins in managing dyslipidemia?
What is the primary mechanism of action for statins in managing dyslipidemia?
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Which lipid-lowering agent is most appropriate for a patient with muscle-related side effects from statin therapy?
Which lipid-lowering agent is most appropriate for a patient with muscle-related side effects from statin therapy?
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What counseling point is crucial to inform patients starting lipid-lowering therapy with statins?
What counseling point is crucial to inform patients starting lipid-lowering therapy with statins?
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In lipid metabolism, what process is specifically involved in the breakdown of triglycerides after a meal?
In lipid metabolism, what process is specifically involved in the breakdown of triglycerides after a meal?
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Which of the following statements about non-statin agents is true?
Which of the following statements about non-statin agents is true?
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Which factor should be considered during the selection of lipid-lowering therapies?
Which factor should be considered during the selection of lipid-lowering therapies?
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What is the key function of HDL in lipid metabolism?
What is the key function of HDL in lipid metabolism?
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Which statement correctly defines secondary prevention in relation to ASCVD?
Which statement correctly defines secondary prevention in relation to ASCVD?
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Which condition is an example of an event that indicates a diagnosis of ASCVD?
Which condition is an example of an event that indicates a diagnosis of ASCVD?
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Which of the following risk factors is NOT included in the formula for ASCVD risk?
Which of the following risk factors is NOT included in the formula for ASCVD risk?
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In the context of ASCVD progression, what does 'occlusion' primarily refer to?
In the context of ASCVD progression, what does 'occlusion' primarily refer to?
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What does the term 'dyslipidemia' specifically refer to in the context of ASCVD?
What does the term 'dyslipidemia' specifically refer to in the context of ASCVD?
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Which of the following best describes the nature of angina pectoris in relation to ASCVD?
Which of the following best describes the nature of angina pectoris in relation to ASCVD?
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In considering medications for dyslipidemia, which class of medication is primarily used to lower LDL cholesterol levels?
In considering medications for dyslipidemia, which class of medication is primarily used to lower LDL cholesterol levels?
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What type of counseling would be most appropriate for a patient with dyslipidemia risk factors?
What type of counseling would be most appropriate for a patient with dyslipidemia risk factors?
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Study Notes
Dyslipidemia Pathophysiology & Pharmacotherapy
- Dyslipidemia is a broad term for lipid abnormalities.
- Pathophysiology involves describing the components of lipoproteins and their functions.
- It includes explaining lipid metabolism via exogenous and endogenous pathways.
- Identifying risk factors for dyslipidemia and associated cardiovascular disease (ASCVD).
- Describing different types of dyslipidemias.
- Pharmacotherapy involves utilizing clinical tools to assess ASCVD risk.
- Describing the mechanism of action, side effects, and counseling points for statins and non-statin agents.
- Applying patient characteristics to select appropriate lipid-lowering therapies to manage dyslipidemia and reduce the risk of ASCVD.
- Developing monitoring and follow-up plans to further optimize therapies or manage adverse effects.
Learning Objectives
- Describe lipoproteins and their functions in the body.
- Explain the steps of lipid metabolism (exogenous and endogenous).
- Identify risk factors for dyslipidemia and ASCVD.
- Characterize different types of dyslipidemias.
- Utilize clinical information and calculators to assess ASCVD risk.
- Describe the mechanism of action, side effects, and counseling points for statins and non-statin agents.
- Apply patient characteristics to select appropriate lipid-lowering therapies.
- Develop monitoring and follow-up plans for dyslipidemia treatment.
Readings
- DiPiro's Pharmacotherapy Chapter 32 (Dyslipidemia)
- 2018 AHA/ACC/Multisociety Guideline on the Management of Blood Cholesterol
Videos for Clarification
- Cholesterol Good and Bad (US National Library of Medicine)
- Physiology of Lipoprotein Cholesterol (Armando Hasudungan)
- Physiology of Lipoprotein Metabolism (National Heart, Lung, and Blood Institute)
Roadmap for Dyslipidemia
- Flowchart outlining the process of assessing and managing dyslipidemia, including ASCVD risk assessment, lipoprotein analysis, medication selection, treatment pathways, and monitoring and follow-up.
ASCVD and Terminology
- Atherosclerotic Cardiovascular Disease (ASCVD)
- Plaque formation within arteries restricts blood flow to organs.
- Conditions are categorized by location of the plaque.
- These do not include venous system conditions such as venous thromboembolism.
Primary vs. Secondary Risk
- Secondary prevention involves patients with a prior diagnosis of ASCVD.
- Primary prevention involves patients at risk of ASCVD but who have not yet had an event
Progression of ASCVD
- The process of plaque buildup in arteries (atherosclerosis).
- Stages: Normal artery > Fatty streaks > Complicated lesions > Occlusion and decreased oxygen delivery > ASCVD event
The "Clogged Pipes"
- Analogy describing how fatty acids (like food) build up in blood vessels/atherosclerosis just like food builds in a drain.
Review Question #1
- Venous thromboembolism is not considered a diagnosis of ASCVD.
What is a Lipid?
- Lipids are a diverse group of hydrophobic organic molecules, used throughout the body for vital functions.
- They are often long-chain molecules.
- Some lipids are amphipathic (having both hydrophilic and hydrophobic parts).
- The more hydrogens & single bonds, the more saturated the molecule.
Lipids throughout the Body
- Phospholipids form cell membranes.
- Triglycerides store energy.
- Fatty acids are metabolized for energy.
- Cholesterol is crucial for hormone, bile production, fat metabolism.
Cholesterol
- Cholesterol is a large molecule with various metabolic functions, including steroid hormones, vitamin production, and bile acid formation.
Triglycerides
- Triglycerides composed of glycerol and fatty acids.
- Triglycerides play a role in energy storage
Lipoproteins
- Lipoproteins carry lipids in the blood.
- Vary in size, ratio of lipids to proteins, specific apolipoproteins, & play critical roles in atherosclerosis.
Types of Lipoproteins
- There are four main categories: Chylomicrons, VLDL, LDL, and HDL.
- Classified based on size, density (lipids vs proteins), and specific proteins (apolipoproteins).
- Important for transporting cholesterol throughout the body
Apoproteins and ASCVD Risk
- Apoproteins (apolipoproteins) are proteins associated with lipoproteins
- ApoB is a key marker for increased ASCVD risk
- HDL does not contain ApoB, and so is not associated with increased risk
Review Question #2
- HDL contains the least triglycerides of all lipoproteins.
Review Question #3
- Chylomicrons are important for maintaining the exogenous cholesterol pathway.
Roadmap - Dyslipidemia
- Flow chart for diagnosing and managing dyslipidemia. Shows progression of ASCVD and related risk factors.
Dyslipidemia Conditions and Classifications
- Categorizes dyslipidemias as primary (familial) or secondary
- Primary - due to genetic abnormalities.
- Secondary - due to many factors; environmental.
- Steps for classification are included.
Familial or Primary Hypercholesterolemia
- Includes heterozygous and homozygous genetic forms.
- Characterized by high LDL cholesterol levels, often appearing at a younger age. Includes screening for family history.
Clinical Presentation
- Many patients with dyslipidemia have no symptoms (asymptomatic).
- Manifestations can be related to metabolic syndrome and other signs (e.g. Xanthomas, peripheral polyneuropathy).
Secondary Causes - Diseases & Disorders
- List of disorders and disease states that can contribute to dyslipidemia.
Secondary Causes - Drugs
- List of drugs/medications that can contribute to/induce dyslipidemia.
Secondary Causes - Diet
- Dietary factors linked to dyslipidemia.
Epidemiology
- Prevalence of dyslipidemia in the population, particularly elevated total and LDL cholesterol.
- Significant contributor to ASCVD and cardiovascular-related deaths.
Epidemiology
- High likelihood of recurrence after a primary ASCVD event in a patient.
- Secondary prevention plays a crucial role in preventing further cardiovascular events in those with a history of ASCVD.
Social Determinants of Health
- Social circumstances affect various aspects of health and can impact one's access to food, healthcare, etc.
Review Question #4
- Testosterone use is associated with increased ASCVD risk.
Biomarkers 101
- Define biomarker.
- Rationale for measuring lipid levels, blood pressure or other ASCVD risk markers
Lab Tests - Lipid Panels
- Components of a lipid panel (include total cholesterol, HDL, LDL, and triglycerides).
- How these tests are used for screening and guiding treatment
Calculating LDL-C
- Friedewald equation to calculate LDL-C from total cholesterol, HDL and triglycerides.
- Accuracy of the Friedewald equation and when other equations should be used.
- Calculating overall accuracy of estimating LDL-C.
Fasting vs. Non-Fasting
- Difference in how lab tests are performed in the fasting and non-fasting state and impact on the lab results.
Other Lab Tests
- List of additional lab tests to assess cardiovascular risk. Includes ApoB, Lp(a), hsCRP, serum Creatinine (SCr), Hemoglobin A1C/Glucose, and LFTs. Includes the role of CPK in assessing skeletal muscle breakdown in relation to treatment.
Coronary Artery Calcium (CAC)
- Noninvasive scan (CT) measuring the amount of calcium in the coronary arteries.
- Cost-effective for assessing cardiovascular risk in patients who have risk factors like primary prevention.
Calculators
- Use of calculators like the Framingham Risk Score, Pooled Cohort Equation and PREVENT Calculator.
Pooled Cohort Equation (PCE)
- Detailed description of the PCE calculator; how these tools estimate a patient’s risk in developing ASCVD.
PREVENT Calculator
- Description of the PREVENT calculator and its utility for ASCVD risk assessment in various ages and risk factors.
Categorizing Based on Risk
- Criteria classifying ASCVD risk into different categories (low, borderline, intermediate, high) based on a 10-year risk score.
Review Question #5
- Steps to calculate LDL-C and classify the patient.
- Different scenarios affecting a patient's ASCVD risk.
Next Week
- Outline information regarding lipid-lowering medications.
- Considerations involving lifestyle modification, treatment pathways, monitoring and follow-up, and optimization of therapy for patients with dyslipidemia.
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Description
Test your knowledge on the management of dyslipidemia and its role in reducing ASCVD risk. This quiz covers misconceptions, risk factors, and the impact of social determinants of health on patient outcomes. Perfect for healthcare professionals looking to enhance their understanding.
