Podcast
Questions and Answers
What is one of the primary treatment goals of managing metabolic syndrome?
What is one of the primary treatment goals of managing metabolic syndrome?
- Lowering waist circumference only
- Eliminating the risk of type 2 diabetes
- Increasing LDL cholesterol levels
- Reducing the risk for atherosclerotic disease (correct)
What is a common consequence of high triglyceride (TG) levels?
What is a common consequence of high triglyceride (TG) levels?
- Increased risk for ASCVD (correct)
- Decreased HDL cholesterol
- Hyperglycemia
- Increased LDL cholesterol
How many metabolic abnormalities are required for a diagnosis of metabolic syndrome?
How many metabolic abnormalities are required for a diagnosis of metabolic syndrome?
- One or more
- Four or more
- Three or more (correct)
- Two or more
Which class of drugs is considered the most effective for lowering LDL cholesterol?
Which class of drugs is considered the most effective for lowering LDL cholesterol?
Which of the following cholesterol-related factors is considered a risk factor for metabolic syndrome?
Which of the following cholesterol-related factors is considered a risk factor for metabolic syndrome?
Which medication is specifically used if triglyceride levels remain high despite treatment?
Which medication is specifically used if triglyceride levels remain high despite treatment?
What is a beneficial effect of statins aside from lowering LDL cholesterol?
What is a beneficial effect of statins aside from lowering LDL cholesterol?
What lifestyle changes are recommended to address metabolic syndrome?
What lifestyle changes are recommended to address metabolic syndrome?
Which of the following statements regarding metabolic syndrome is debatable among healthcare professionals?
Which of the following statements regarding metabolic syndrome is debatable among healthcare professionals?
What is often the first step in treating high triglyceride (TG) levels?
What is often the first step in treating high triglyceride (TG) levels?
What is the recommended level of HDL cholesterol for men defined as low?
What is the recommended level of HDL cholesterol for men defined as low?
What role does hypertension play in metabolic syndrome?
What role does hypertension play in metabolic syndrome?
What aspect of cholesterol treatment do all drugs for lowering LDL cholesterol generally offer?
What aspect of cholesterol treatment do all drugs for lowering LDL cholesterol generally offer?
In patients with metabolic syndrome, what measurement indicates abdominal obesity for women?
In patients with metabolic syndrome, what measurement indicates abdominal obesity for women?
Which statin is associated with the highest risk for rhabdomyolysis?
Which statin is associated with the highest risk for rhabdomyolysis?
What is the absolute risk of serious myopathy when using statins?
What is the absolute risk of serious myopathy when using statins?
What additional strategy can help manage myalgia in patients taking statins?
What additional strategy can help manage myalgia in patients taking statins?
When should liver function tests be conducted for patients starting statin therapy?
When should liver function tests be conducted for patients starting statin therapy?
In which condition are statins considered acceptable therapy?
In which condition are statins considered acceptable therapy?
What is the risk of new-onset diabetes with statin use?
What is the risk of new-onset diabetes with statin use?
Which of the following medications is likely to increase the risk of statin-related adverse events?
Which of the following medications is likely to increase the risk of statin-related adverse events?
What dietary item should statin users avoid due to its effect on CYP3A4?
What dietary item should statin users avoid due to its effect on CYP3A4?
Why are statins contraindicated in pregnancy?
Why are statins contraindicated in pregnancy?
Which statins are preferred for patients with significant renal impairment?
Which statins are preferred for patients with significant renal impairment?
Which factor is NOT considered when selecting a statin?
Which factor is NOT considered when selecting a statin?
What is the recommended action if serum transaminase levels rise to three times the upper limit of normal (ULN)?
What is the recommended action if serum transaminase levels rise to three times the upper limit of normal (ULN)?
What should be monitored at baseline and as clinically indicated after starting statins?
What should be monitored at baseline and as clinically indicated after starting statins?
What may individuals with prediabetes experience when using statins?
What may individuals with prediabetes experience when using statins?
What is the primary therapeutic goal of bile acid sequestrants?
What is the primary therapeutic goal of bile acid sequestrants?
What is the primary therapeutic goal when prescribing statins?
What is the primary therapeutic goal when prescribing statins?
Which of the following medications should be administered to avoid interactions with bile acid sequestrants?
Which of the following medications should be administered to avoid interactions with bile acid sequestrants?
Which adverse effect is most commonly associated with bile acid sequestrants?
Which adverse effect is most commonly associated with bile acid sequestrants?
What common side effect is minimized by increasing dietary fiber and fluid intake while using bile acid sequestrants?
What common side effect is minimized by increasing dietary fiber and fluid intake while using bile acid sequestrants?
What is the effect of bile acid sequestrants on LDL cholesterol levels over time?
What is the effect of bile acid sequestrants on LDL cholesterol levels over time?
What is the mechanism of action of ezetimibe?
What is the mechanism of action of ezetimibe?
What precaution should be observed when prescribing rosuvastatin to Asian patients?
What precaution should be observed when prescribing rosuvastatin to Asian patients?
What effect can ezetimibe have on HDL cholesterol levels?
What effect can ezetimibe have on HDL cholesterol levels?
What is a significant risk associated with combining ezetimibe and statins?
What is a significant risk associated with combining ezetimibe and statins?
What role does colesevelam play in managing diabetes?
What role does colesevelam play in managing diabetes?
Why was niacin recommended for removal from guidelines in 2016?
Why was niacin recommended for removal from guidelines in 2016?
Which of the following is NOT a known interaction of ezetimibe?
Which of the following is NOT a known interaction of ezetimibe?
Which of the following is NOT a reason colesevelam is preferred over older bile acid sequestrants?
Which of the following is NOT a reason colesevelam is preferred over older bile acid sequestrants?
Why are fibrates considered third-line drugs for managing lipid disorders?
Why are fibrates considered third-line drugs for managing lipid disorders?
What is the principal indication for gemfibrozil?
What is the principal indication for gemfibrozil?
Bile acid sequestrants are considered safe as they are:
Bile acid sequestrants are considered safe as they are:
What is the first step in monitoring patients on statins?
What is the first step in monitoring patients on statins?
How much can gemfibrozil decrease VLDL levels based on treatment?
How much can gemfibrozil decrease VLDL levels based on treatment?
What impact do fibrates have on HDL cholesterol levels?
What impact do fibrates have on HDL cholesterol levels?
In patients with high VLDL levels, bile acid sequestrants may result in:
In patients with high VLDL levels, bile acid sequestrants may result in:
Which of the following is an adverse effect that has been reported with ezetimibe?
Which of the following is an adverse effect that has been reported with ezetimibe?
Which of the following measures is used to evaluate therapeutic effects of statins?
Which of the following measures is used to evaluate therapeutic effects of statins?
An important consideration when taking bile acid sequestrants is:
An important consideration when taking bile acid sequestrants is:
What is the recommended timing for administering ezetimibe relative to bile acid sequestrants?
What is the recommended timing for administering ezetimibe relative to bile acid sequestrants?
Which of the following substances can gemfibrozil NOT effectively lower?
Which of the following substances can gemfibrozil NOT effectively lower?
What is an important contraindication for the use of statins?
What is an important contraindication for the use of statins?
What should patients taking statins report to their provider?
What should patients taking statins report to their provider?
What is the primary therapeutic use of gemfibrozil?
What is the primary therapeutic use of gemfibrozil?
What should patients taking gemfibrozil be advised to report?
What should patients taking gemfibrozil be advised to report?
Which of the following conditions contraindicates the use of gemfibrozil?
Which of the following conditions contraindicates the use of gemfibrozil?
Gemfibrozil can increase the risk of which adverse effect due to its mechanism of action?
Gemfibrozil can increase the risk of which adverse effect due to its mechanism of action?
What is the likely reason for gemfibrozil's benefits in patients with normal LDL cholesterol and low HDL cholesterol?
What is the likely reason for gemfibrozil's benefits in patients with normal LDL cholesterol and low HDL cholesterol?
Which of the following is a recommended monitoring approach for patients on gemfibrozil?
Which of the following is a recommended monitoring approach for patients on gemfibrozil?
What is the mechanism of action of PCSK9 inhibitors?
What is the mechanism of action of PCSK9 inhibitors?
What common adverse effect is associated with the use of PCSK9 inhibitors?
What common adverse effect is associated with the use of PCSK9 inhibitors?
What should be monitored in patients taking warfarin in conjunction with gemfibrozil?
What should be monitored in patients taking warfarin in conjunction with gemfibrozil?
In which of the following scenarios would the combination of a statin with gemfibrozil be most appropriate?
In which of the following scenarios would the combination of a statin with gemfibrozil be most appropriate?
Which lipid class do PCSK9 inhibitors primarily target for reduction?
Which lipid class do PCSK9 inhibitors primarily target for reduction?
Which of the following statements regarding gemfibrozil is true?
Which of the following statements regarding gemfibrozil is true?
What factor should be considered when using PCSK9 inhibitors?
What factor should be considered when using PCSK9 inhibitors?
Which of the following is TRUE about gemfibrozil's impact on LDL levels?
Which of the following is TRUE about gemfibrozil's impact on LDL levels?
What is the primary reason for prescribing statins for primary prevention?
What is the primary reason for prescribing statins for primary prevention?
Which statin is specifically mentioned as effective for patients with normal LDL levels but increased CV risk?
Which statin is specifically mentioned as effective for patients with normal LDL levels but increased CV risk?
For which group of patients is it recommended to start statins immediately after an MI?
For which group of patients is it recommended to start statins immediately after an MI?
What is the American Diabetes Association's recommendation regarding statins for patients over 40 years old?
What is the American Diabetes Association's recommendation regarding statins for patients over 40 years old?
What is the principal site where statins exert their effects?
What is the principal site where statins exert their effects?
Which side effect is commonly associated with the use of statins?
Which side effect is commonly associated with the use of statins?
What enhanced risk factor is NOT associated with statin-induced myopathy?
What enhanced risk factor is NOT associated with statin-induced myopathy?
How are statins primarily excreted from the body?
How are statins primarily excreted from the body?
Which of the following statins is metabolized through CYP3A4?
Which of the following statins is metabolized through CYP3A4?
What is the risk associated with the concurrent use of certain medications that inhibit CYP3A4 in patients taking statins?
What is the risk associated with the concurrent use of certain medications that inhibit CYP3A4 in patients taking statins?
What is the incidence rate of fatal rhabdomyolysis associated with statin use?
What is the incidence rate of fatal rhabdomyolysis associated with statin use?
Which characteristic symptoms indicate mild statin-induced myopathy?
Which characteristic symptoms indicate mild statin-induced myopathy?
Why should statin doses be reduced for individuals of Asian heritage?
Why should statin doses be reduced for individuals of Asian heritage?
What should be monitored if a patient on statins develops symptoms of myopathy?
What should be monitored if a patient on statins develops symptoms of myopathy?
A patient experiences muscle pain while on statins. What initial action should be taken regarding the statin prescription?
A patient experiences muscle pain while on statins. What initial action should be taken regarding the statin prescription?
What type of cholesterol is most directly related to the risk of developing atherosclerotic cardiovascular disease (ASCVD)?
What type of cholesterol is most directly related to the risk of developing atherosclerotic cardiovascular disease (ASCVD)?
What condition is characterized by deposition of fibrous plaque in the arterial wall?
What condition is characterized by deposition of fibrous plaque in the arterial wall?
Which of the following consequences is primarily associated with severe atherosclerotic cardiovascular disease (ASCVD)?
Which of the following consequences is primarily associated with severe atherosclerotic cardiovascular disease (ASCVD)?
What is the primary method for reducing the risk of serious atherosclerotic cardiovascular disease (ASCVD)?
What is the primary method for reducing the risk of serious atherosclerotic cardiovascular disease (ASCVD)?
What initial manifestation commonly indicates moderate cardiac ASCVD?
What initial manifestation commonly indicates moderate cardiac ASCVD?
What can a ruptured atherosclerotic lesion cause?
What can a ruptured atherosclerotic lesion cause?
Which demographic is primarily affected by atherosclerotic cardiovascular disease, according to the statistics provided?
Which demographic is primarily affected by atherosclerotic cardiovascular disease, according to the statistics provided?
Which term refers to the initial phase of atherosclerotic cardiovascular disease characterized by fatty streaks?
Which term refers to the initial phase of atherosclerotic cardiovascular disease characterized by fatty streaks?
What is considered a high ASCVD risk percentage according to the guidelines?
What is considered a high ASCVD risk percentage according to the guidelines?
Which of the following is NOT a major positive risk factor for ASCVD?
Which of the following is NOT a major positive risk factor for ASCVD?
Which scoring instrument is most commonly used to calculate 10-year ASCVD risk?
Which scoring instrument is most commonly used to calculate 10-year ASCVD risk?
What are therapeutic lifestyle changes primarily aimed at improving?
What are therapeutic lifestyle changes primarily aimed at improving?
What is the role of statins in cholesterol management according to the guidelines?
What is the role of statins in cholesterol management according to the guidelines?
How is diabetes classified in relation to ASCVD risk?
How is diabetes classified in relation to ASCVD risk?
What is the intended benefit of drug therapy in cholesterol management?
What is the intended benefit of drug therapy in cholesterol management?
What is the primary method for lowering LDL cholesterol?
What is the primary method for lowering LDL cholesterol?
What role does cholesterol play in the body?
What role does cholesterol play in the body?
What factor should be included when calculating the Framingham Risk Prediction Score?
What factor should be included when calculating the Framingham Risk Prediction Score?
When should drug therapy for high LDL cholesterol be initiated?
When should drug therapy for high LDL cholesterol be initiated?
Which class of lipoproteins is primarily responsible for delivering triglycerides from the liver?
Which class of lipoproteins is primarily responsible for delivering triglycerides from the liver?
What is one example of a drug used to treat high cholesterol?
What is one example of a drug used to treat high cholesterol?
What enzyme is a critical catalyst in hepatic cholesterol synthesis?
What enzyme is a critical catalyst in hepatic cholesterol synthesis?
What is a key consideration regarding the continued use of LDL cholesterol-lowering drugs?
What is a key consideration regarding the continued use of LDL cholesterol-lowering drugs?
What effect does an increase in dietary saturated fats have on circulating cholesterol levels?
What effect does an increase in dietary saturated fats have on circulating cholesterol levels?
How many categories of patients benefit from statin treatment under the 2018 ACC/AHA guidelines?
How many categories of patients benefit from statin treatment under the 2018 ACC/AHA guidelines?
What is the primary core lipid of low-density lipoproteins (LDLs)?
What is the primary core lipid of low-density lipoproteins (LDLs)?
How do LDL receptors on cells influence cholesterol absorption?
How do LDL receptors on cells influence cholesterol absorption?
Why is high HDL cholesterol considered a negative risk factor?
Why is high HDL cholesterol considered a negative risk factor?
What role do lifestyles modifications have in cholesterol management?
What role do lifestyles modifications have in cholesterol management?
What is the main physiologic role of high-density lipoproteins (HDLs)?
What is the main physiologic role of high-density lipoproteins (HDLs)?
What happens when dietary cholesterol intake increases?
What happens when dietary cholesterol intake increases?
Which lipoprotein accounts for the majority of cholesterol in the blood?
Which lipoprotein accounts for the majority of cholesterol in the blood?
What effect does increasing LDL receptor expression have on cholesterol levels?
What effect does increasing LDL receptor expression have on cholesterol levels?
Which of the following statements about plasma lipoproteins is correct?
Which of the following statements about plasma lipoproteins is correct?
What is the primary composition of the hydrophobic core of lipoproteins?
What is the primary composition of the hydrophobic core of lipoproteins?
Which class of lipoproteins is primarily involved in the delivery of dietary fats?
Which class of lipoproteins is primarily involved in the delivery of dietary fats?
What is the relationship between LDL levels and the risk of ASCVD?
What is the relationship between LDL levels and the risk of ASCVD?
What do high levels of HDL cholesterol do in relation to ASCVD?
What do high levels of HDL cholesterol do in relation to ASCVD?
What process begins when LDLs penetrate the arterial wall?
What process begins when LDLs penetrate the arterial wall?
Which of the following is a consequence of oxidized LDLs?
Which of the following is a consequence of oxidized LDLs?
What indicates a mature atherosclerotic lesion?
What indicates a mature atherosclerotic lesion?
What major risk factor contributes to the development of ASCVD according to the guidelines?
What major risk factor contributes to the development of ASCVD according to the guidelines?
Which of the following correctly describes foam cells?
Which of the following correctly describes foam cells?
What happens when the fibrous cap of an atherosclerotic plaque ruptures?
What happens when the fibrous cap of an atherosclerotic plaque ruptures?
What lifestyle changes are recommended for high ASCVD risk individuals?
What lifestyle changes are recommended for high ASCVD risk individuals?
What is the main goal of using cholesterol-lowering drugs?
What is the main goal of using cholesterol-lowering drugs?
What is the primary action of statins in patients with atherosclerosis?
What is the primary action of statins in patients with atherosclerosis?
Which type of cholesterol is referred to as 'bad cholesterol'?
Which type of cholesterol is referred to as 'bad cholesterol'?
What role does the National Cholesterol Education Program (NCEP) serve?
What role does the National Cholesterol Education Program (NCEP) serve?
How quickly do statins typically show a significant reduction in LDL cholesterol levels?
How quickly do statins typically show a significant reduction in LDL cholesterol levels?
What is one of the non-lipid beneficial cardiovascular actions of statins?
What is one of the non-lipid beneficial cardiovascular actions of statins?
What effect does reducing LDL cholesterol levels have on the risk for major cardiovascular events?
What effect does reducing LDL cholesterol levels have on the risk for major cardiovascular events?
Which of the following statements is true about the development of atherosclerosis?
Which of the following statements is true about the development of atherosclerosis?
What risks do statins help lower in patients with ASCVD?
What risks do statins help lower in patients with ASCVD?
What mechanism do statins employ to lower LDL cholesterol levels?
What mechanism do statins employ to lower LDL cholesterol levels?
What is a characteristic of the HDL cholesterol levels in patients at high risk for ASCVD?
What is a characteristic of the HDL cholesterol levels in patients at high risk for ASCVD?
Which of the following adverse effects is a reason for discontinuing statin therapy?
Which of the following adverse effects is a reason for discontinuing statin therapy?
What is the effect on serum cholesterol levels if statin therapy is stopped?
What is the effect on serum cholesterol levels if statin therapy is stopped?
Which statin may be approved for primary prevention in specific patients with normal LDL levels?
Which statin may be approved for primary prevention in specific patients with normal LDL levels?
What factor is attributed to the effectiveness of statins in lowering LDL cholesterol in the liver?
What factor is attributed to the effectiveness of statins in lowering LDL cholesterol in the liver?
Which of the following is a reason statins might still be effective in patients with normal LDL levels?
Which of the following is a reason statins might still be effective in patients with normal LDL levels?
In terms of dosage, what is a typical reduction of LDL cholesterol after statin therapy?
In terms of dosage, what is a typical reduction of LDL cholesterol after statin therapy?
What is one potential short-term effect of statin therapy on triglyceride levels?
What is one potential short-term effect of statin therapy on triglyceride levels?
Flashcards
Atherosclerotic Cardiovascular Disease (ASCVD)
Atherosclerotic Cardiovascular Disease (ASCVD)
A type of cardiovascular disease that affects the arteries of the heart and brain, leading to heart attacks and strokes.
Fatty Streak
Fatty Streak
A fatty buildup in the arterial wall that is the initial stage of atherosclerosis.
Fibrous plaque
Fibrous plaque
A buildup of fibrous tissue in the arterial wall, a progression of atherosclerosis.
Hyperlipidemia
Hyperlipidemia
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Low-Density Lipoprotein (LDL)
Low-Density Lipoprotein (LDL)
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High-Density Lipoprotein (HDL)
High-Density Lipoprotein (HDL)
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Thrombus
Thrombus
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Myocardial infarction (MI)
Myocardial infarction (MI)
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Cholesterol
Cholesterol
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Exogenous Cholesterol
Exogenous Cholesterol
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Endogenous Cholesterol
Endogenous Cholesterol
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HMG-CoA Reductase
HMG-CoA Reductase
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Atherogenesis
Atherogenesis
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Lipoproteins
Lipoproteins
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Apolipoproteins
Apolipoproteins
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Very-Low-Density Lipoproteins (VLDLs)
Very-Low-Density Lipoproteins (VLDLs)
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Endocytosis
Endocytosis
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LDL Receptors
LDL Receptors
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Statins
Statins
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Triglycerides (TGs)
Triglycerides (TGs)
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What is LDL cholesterol?
What is LDL cholesterol?
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What is HDL cholesterol?
What is HDL cholesterol?
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What is LDL oxidation?
What is LDL oxidation?
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What are foam cells?
What are foam cells?
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What is a fatty streak?
What is a fatty streak?
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What is a fibrous plaque?
What is a fibrous plaque?
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Why is atherosclerosis considered an inflammatory process?
Why is atherosclerosis considered an inflammatory process?
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What is a mature atherosclerotic lesion?
What is a mature atherosclerotic lesion?
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What is plaque rupture?
What is plaque rupture?
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What is a thrombus?
What is a thrombus?
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What is hyperlipidemia?
What is hyperlipidemia?
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What is Atherosclerotic Cardiovascular Disease (ASCVD)?
What is Atherosclerotic Cardiovascular Disease (ASCVD)?
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What is a myocardial infarction (MI)?
What is a myocardial infarction (MI)?
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What is LDL transport into the arterial wall?
What is LDL transport into the arterial wall?
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What is macrophage uptake of LDL cholesterol?
What is macrophage uptake of LDL cholesterol?
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ASCVD Risk Assessment
ASCVD Risk Assessment
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2018 ACC/AHA Cholesterol Guidelines
2018 ACC/AHA Cholesterol Guidelines
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ASCVD Risk Factors
ASCVD Risk Factors
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Diabetes as an ASCVD Risk Equivalent
Diabetes as an ASCVD Risk Equivalent
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Framingham Risk Prediction Score
Framingham Risk Prediction Score
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Interpreting Framingham Risk Score
Interpreting Framingham Risk Score
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Very High ASCVD Risk Category
Very High ASCVD Risk Category
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Statin Treatment for High ASCVD Risk
Statin Treatment for High ASCVD Risk
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Therapeutic Lifestyle Changes (TLCs)
Therapeutic Lifestyle Changes (TLCs)
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Drug Therapy vs. TLCs
Drug Therapy vs. TLCs
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Statins for Cholesterol Lowering
Statins for Cholesterol Lowering
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Primary Prevention with Drug Therapy
Primary Prevention with Drug Therapy
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Lifelong Medication Requirement
Lifelong Medication Requirement
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Alternatives to Statins
Alternatives to Statins
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Monoclonal Antibodies for Cholesterol
Monoclonal Antibodies for Cholesterol
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Metabolic Syndrome
Metabolic Syndrome
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High Triglycerides
High Triglycerides
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Bile Acid Sequestrants
Bile Acid Sequestrants
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Fibrates
Fibrates
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Ezetimibe
Ezetimibe
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Metabolic Syndrome Treatment
Metabolic Syndrome Treatment
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Fibrates for High TGs
Fibrates for High TGs
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LDL Lowering Drugs and HDL Increase
LDL Lowering Drugs and HDL Increase
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High LDL Cholesterol
High LDL Cholesterol
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Low HDL Cholesterol
Low HDL Cholesterol
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High Total Cholesterol
High Total Cholesterol
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Dyslipidemias
Dyslipidemias
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Drugs that Lower LDL Cholesterol
Drugs that Lower LDL Cholesterol
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Primary prevention with statins
Primary prevention with statins
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Secondary prevention with statins
Secondary prevention with statins
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How statins reduce cardiovascular risk
How statins reduce cardiovascular risk
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Statins for people with normal cholesterol
Statins for people with normal cholesterol
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Evidence for Statin use in normal cholesterol
Evidence for Statin use in normal cholesterol
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Statins after a heart attack
Statins after a heart attack
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Cardiovascular disease in diabetes
Cardiovascular disease in diabetes
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ADA Guidelines for statins in diabetes
ADA Guidelines for statins in diabetes
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ACP Guidelines for statins in diabetes
ACP Guidelines for statins in diabetes
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Statin pharmacokinetics (absorption and action)
Statin pharmacokinetics (absorption and action)
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Statin pharmacokinetics (metabolism and excretion)
Statin pharmacokinetics (metabolism and excretion)
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Influence of CYP3A4 on statin levels
Influence of CYP3A4 on statin levels
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Rosuvastatin dosage in Asians
Rosuvastatin dosage in Asians
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Common side effects of statins
Common side effects of statins
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Serious side effects of statins
Serious side effects of statins
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What are statins and what is their primary mechanism of action?
What are statins and what is their primary mechanism of action?
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When is the optimal time to take statins?
When is the optimal time to take statins?
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What are the non-lipid beneficial cardiovascular actions of statins?
What are the non-lipid beneficial cardiovascular actions of statins?
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How do statins reduce LDL cholesterol?
How do statins reduce LDL cholesterol?
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What is the role of statins in primary and secondary prevention of cardiovascular events?
What is the role of statins in primary and secondary prevention of cardiovascular events?
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Are statins only prescribed for patients with high LDL levels?
Are statins only prescribed for patients with high LDL levels?
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What are the clinical outcomes improved by statins?
What are the clinical outcomes improved by statins?
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Do statins have any effect on triglyceride levels?
Do statins have any effect on triglyceride levels?
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What is the typical LDL cholesterol target for statin therapy?
What is the typical LDL cholesterol target for statin therapy?
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Is statin therapy a short-term or long-term treatment?
Is statin therapy a short-term or long-term treatment?
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What are the potential side effects of statins?
What are the potential side effects of statins?
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Are statins safe and effective for everyone?
Are statins safe and effective for everyone?
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Do statins interact with other medications?
Do statins interact with other medications?
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What is the overarching goal of statin therapy?
What is the overarching goal of statin therapy?
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Highest risk of rhabdomyolysis with statins
Highest risk of rhabdomyolysis with statins
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Statins: myopathy vs. untreated LDL
Statins: myopathy vs. untreated LDL
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Managing statin-related myalgia
Managing statin-related myalgia
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Statins and liver injury
Statins and liver injury
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Discontinuing statins for elevated liver enzymes
Discontinuing statins for elevated liver enzymes
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Statins and nonalcoholic fatty liver disease
Statins and nonalcoholic fatty liver disease
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Statins and new-onset diabetes
Statins and new-onset diabetes
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Statin interactions with other lipid-lowering drugs
Statin interactions with other lipid-lowering drugs
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Statin interactions with CYP3A4 inhibitors
Statin interactions with CYP3A4 inhibitors
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Grapefruit interaction with statins
Grapefruit interaction with statins
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Statins and pregnancy
Statins and pregnancy
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Effective statins for significant LDL reduction
Effective statins for significant LDL reduction
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Statins for patients with kidney problems
Statins for patients with kidney problems
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Factors influencing statin selection
Factors influencing statin selection
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Colesevelam (Welchol)
Colesevelam (Welchol)
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Mechanism of Action of Bile Acid Sequestrants
Mechanism of Action of Bile Acid Sequestrants
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Effect of Bile Acid Sequestrants on LDL Cholesterol
Effect of Bile Acid Sequestrants on LDL Cholesterol
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Effect of Bile Acid Sequestrants on VLDL Levels
Effect of Bile Acid Sequestrants on VLDL Levels
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Constipation
Constipation
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Combined Therapy with Statins
Combined Therapy with Statins
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Colesevelam and Diabetes
Colesevelam and Diabetes
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Therapeutic Goal of Statins
Therapeutic Goal of Statins
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Rosuvastatin Dosing in Asians
Rosuvastatin Dosing in Asians
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Bile acid sequestrants and fat-soluble vitamins
Bile acid sequestrants and fat-soluble vitamins
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How do bile acid sequestrants work?
How do bile acid sequestrants work?
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Safety of bile acid sequestrants
Safety of bile acid sequestrants
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How does Ezetimibe work?
How does Ezetimibe work?
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How can Ezetimibe be used?
How can Ezetimibe be used?
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Is Ezetimibe a well-tolerated drug?
Is Ezetimibe a well-tolerated drug?
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Potential interaction between Ezetimibe and statins
Potential interaction between Ezetimibe and statins
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What is the main effect of fibrates?
What is the main effect of fibrates?
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Fibrates as a treatment option
Fibrates as a treatment option
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Potential interaction between fibrates and statins
Potential interaction between fibrates and statins
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Key effects of Gemfibrozil
Key effects of Gemfibrozil
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Primary use of Gemfibrozil
Primary use of Gemfibrozil
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What are cholesterol absorption inhibitors?
What are cholesterol absorption inhibitors?
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Overall effectiveness of cholesterol absorption inhibitors
Overall effectiveness of cholesterol absorption inhibitors
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Side effects of cholesterol absorption inhibitors
Side effects of cholesterol absorption inhibitors
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What is Gemfibrozil?
What is Gemfibrozil?
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When is Gemfibrozil used?
When is Gemfibrozil used?
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What is a potential side effect of Gemfibrozil?
What is a potential side effect of Gemfibrozil?
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What are some drug interactions with Gemfibrozil?
What are some drug interactions with Gemfibrozil?
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How do PCSK9 inhibitors work?
How do PCSK9 inhibitors work?
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Who benefits from PCSK9 inhibitors?
Who benefits from PCSK9 inhibitors?
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How are PCSK9 inhibitors administered?
How are PCSK9 inhibitors administered?
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What are some side effects of PCSK9 inhibitors?
What are some side effects of PCSK9 inhibitors?
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What drug interactions are associated with PCSK9 inhibitors?
What drug interactions are associated with PCSK9 inhibitors?
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What is the importance of considering clinical outcomes in lipid management?
What is the importance of considering clinical outcomes in lipid management?
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What is the first-line treatment for high cholesterol?
What is the first-line treatment for high cholesterol?
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What is the most effective medication for lowering LDL cholesterol?
What is the most effective medication for lowering LDL cholesterol?
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What are alternative medications for lowering LDL cholesterol besides statins?
What are alternative medications for lowering LDL cholesterol besides statins?
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What is a newer class of medication for lowering LDL cholesterol?
What is a newer class of medication for lowering LDL cholesterol?
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What are fibrates used for?
What are fibrates used for?
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Study Notes
Cholesterol-Lowering Drugs
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Cholesterol's Role in ASCVD: High cholesterol, especially LDL cholesterol, significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD). ASCVD damages blood vessels in the heart and brain, potentially leading to heart attacks (MI) and strokes.
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Atherogenesis: ASCVD begins with fatty streaks in arterial walls, followed by plaque buildup. Plaque growth hinders blood flow, increasing risk of blood clots (thrombi) that can block blood supply to the heart or brain. Atherosclerosis affects all arteries, not just those in the heart or brain.
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Dietary Cholesterol vs. Saturated Fat: Reducing saturated fat intake is more crucial than reducing dietary cholesterol for lowering blood cholesterol levels, though both are important considerations.
Lipoproteins
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Lipoprotein Structure and Function: Lipoproteins are spherical structures with a hydrophobic core (cholesterol and triglycerides) and a hydrophilic shell (phospholipids). These structures carry lipids (cholesterol and triglycerides) in the bloodstream, which cannot dissolve directly in the water-based plasma.
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Apolipoproteins: Apolipoproteins, the protein component of lipoproteins, act as recognition sites for cell receptors, activating enzymes that metabolize lipoproteins, and enhancing lipoprotein stability.
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Major Lipoprotein Classes: Very-low-density lipoproteins (VLDLs), low-density lipoproteins (LDLs), and high-density lipoproteins (HDLs) are crucial in coronary atherosclerosis.
- VLDLs: Primarily transport triglycerides from the liver. Elevated triglyceride levels (above 500 mg/dL) increase pancreatitis risk.
- LDLs: Carry cholesterol to non-hepatic tissues. High LDL levels correlate strongly with ASCVD risk. Reducing LDL significantly slows and even reverses atherosclerosis.
- HDLs: Transport cholesterol from tissues back to the liver. High HDL levels reduce ASCVD risk ("good cholesterol").
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LDL vs. HDL Cholesterol: LDL cholesterol promotes atherosclerosis ("bad cholesterol"), while HDL cholesterol reduces ASCVD risk ("good cholesterol").
Cholesterol Screening and Management
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2018 ACC/AHA Guidelines: Emphasize identifying patients most likely to benefit from cholesterol-lowering drugs (statins) by assessing ASCVD risk (10-year risk).
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Risk Assessment Factors: Assessing ASCVD risk involves identifying risk factors, calculating a 10-year ASCVD risk (usually using the Framingham Risk Score), and identifying ASCVD risk equivalents (e.g., diabetes).
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ASCVD Risk Categories: Patients are categorized based on ASCVD presence, number of risk factors (excluding elevated LDL), and 10-year ASCVD risk to determine statin treatment need.
Cholesterol-Lowering Drugs
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Therapeutic Lifestyle Changes (TLCs): These nondrug methods (diet, exercise, weight control, smoking cessation) are the first-line treatment for high cholesterol.
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Drug Therapy: Employed only when TLCs are insufficient or inadequate.
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Statins: Most effective, widely used cholesterol-lowering drugs that inhibit HMG-CoA reductase, and are primarily for LDL reduction. Can also increase HDL and lower triglycerides.
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Statin Mechanism: Statins inhibit cholesterol synthesis. This prompts the liver to produce more LDL receptors, removing LDL cholesterol from the blood.
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Non-lipid benefits: Statins can stabilize atherosclerotic plaques, reduce inflammation, slow calcification, improve vessel dilation, and reduce thrombosis risk.
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Adverse Effects: Statins can cause mild muscle pain or discomfort, rarely muscle damage (myopathy/rhabdomyolysis), and rarely liver damage. Risk factors for myopathy include advanced age, high doses, other medications (fibrates).
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Drug Interactions: Statins interact with drugs inhibiting CYP3A4 (certain antibiotics, antifungals, HIV protease inhibitors) and increase risk of muscle or liver damage when combined with other lipid-lowering medications. Grapefruit should be avoided due to its CYP3A4 inhibition.
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Contraindications: Pregnancy.
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Bile Acid Sequestrants: Primarily for adjunctive use with statins. Bind bile acids in the GI tract, promoting their excretion, increasing the need for cholesterol to create new bile acids, leading to LDL reduction. Common side effects include constipation and GI discomfort.
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Ezetimibe: Inhibits cholesterol absorption in the intestines and lowers LDL. Can be used alone or with statins. May increase risk of muscle or liver damage when combined with statins or fibrates.
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Fibrates: Lower triglycerides and raise HDL but have a limited effect on LDL cholesterol. Used as a third-line therapy; can increase the risk of gallstones and muscle damage
- Gemfibrozil: The primary use is lowering triglycerides. Common adverse effects include skin rash and GI problems, as well as a heightened risk of gallstones and muscle damage. Increased risk of myopathy when combined with statins and may increase anticoagulant effects if used with warfarin.
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PCSK9 Inhibitors: Inhibit the protein PCSK9, enabling more cholesterol removal. Administered subcutaneously. Possible adverse effects include hypersensitivity reactions and antibody formation.
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Other Concerns: Metabolic syndrome involves multiple risk factors for ASCVD, including high triglycerides, low HDL, and hyperglycemia. Managing these risks is important and usually involves lifestyle changes.
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Description
This quiz covers the relationship between cholesterol levels and the risk of atherosclerotic cardiovascular disease (ASCVD). Learn about atherogenesis, the role of dietary fats, and how lipoproteins function in the body. Test your understanding of key concepts in cholesterol management and cardiovascular health.
