Cholesterol-Lowering Drugs and Lipoproteins
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Questions and Answers

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?

  • Increased risk for ASCVD (correct)
  • Decreased HDL cholesterol
  • Hyperglycemia
  • Increased LDL cholesterol

    • 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?

    <p>Statins</p> Signup and view all the answers

    Which of the following cholesterol-related factors is considered a risk factor for metabolic syndrome?

    <p>High apolipoprotein B levels</p> Signup and view all the answers

    Which medication is specifically used if triglyceride levels remain high despite treatment?

    <p>Fibrates</p> Signup and view all the answers

    What is a beneficial effect of statins aside from lowering LDL cholesterol?

    <p>Raising HDL cholesterol</p> Signup and view all the answers

    What lifestyle changes are recommended to address metabolic syndrome?

    <p>Weight control and increased physical activity</p> Signup and view all the answers

    Which of the following statements regarding metabolic syndrome is debatable among healthcare professionals?

    <p>It is considered a specific disease entity.</p> Signup and view all the answers

    What is often the first step in treating high triglyceride (TG) levels?

    <p>Achieving LDL cholesterol goals</p> Signup and view all the answers

    What is the recommended level of HDL cholesterol for men defined as low?

    <p>Below 40 mg/dL</p> Signup and view all the answers

    What role does hypertension play in metabolic syndrome?

    <p>It is commonly associated with metabolic syndrome.</p> Signup and view all the answers

    What aspect of cholesterol treatment do all drugs for lowering LDL cholesterol generally offer?

    <p>They may improve HDL cholesterol to some degree.</p> Signup and view all the answers

    In patients with metabolic syndrome, what measurement indicates abdominal obesity for women?

    <p>35 inches or more</p> Signup and view all the answers

    Which statin is associated with the highest risk for rhabdomyolysis?

    <p>Rosuvastatin</p> Signup and view all the answers

    What is the absolute risk of serious myopathy when using statins?

    <p>Extremely low</p> Signup and view all the answers

    What additional strategy can help manage myalgia in patients taking statins?

    <p>Vitamin D replacement</p> Signup and view all the answers

    When should liver function tests be conducted for patients starting statin therapy?

    <p>Before treatment and if clinically indicated after starting</p> Signup and view all the answers

    In which condition are statins considered acceptable therapy?

    <p>Nonalcoholic fatty liver disease</p> Signup and view all the answers

    What is the risk of new-onset diabetes with statin use?

    <p>1 in 500</p> Signup and view all the answers

    Which of the following medications is likely to increase the risk of statin-related adverse events?

    <p>Macrolide antibiotics</p> Signup and view all the answers

    What dietary item should statin users avoid due to its effect on CYP3A4?

    <p>Grapefruit</p> Signup and view all the answers

    Why are statins contraindicated in pregnancy?

    <p>They can cause fetal malformation</p> Signup and view all the answers

    Which statins are preferred for patients with significant renal impairment?

    <p>Atorvastatin and fluvastatin</p> Signup and view all the answers

    Which factor is NOT considered when selecting a statin?

    <p>Alcohol consumption</p> Signup and view all the answers

    What is the recommended action if serum transaminase levels rise to three times the upper limit of normal (ULN)?

    <p>Discontinue the statin</p> Signup and view all the answers

    What should be monitored at baseline and as clinically indicated after starting statins?

    <p>Liver function tests</p> Signup and view all the answers

    What may individuals with prediabetes experience when using statins?

    <p>Increased risk of developing diabetes</p> Signup and view all the answers

    What is the primary therapeutic goal of bile acid sequestrants?

    <p>Reduce elevated LDL cholesterol levels</p> Signup and view all the answers

    What is the primary therapeutic goal when prescribing statins?

    <p>Lower levels of LDL cholesterol</p> Signup and view all the answers

    Which of the following medications should be administered to avoid interactions with bile acid sequestrants?

    <p>Thiazide diuretics</p> Signup and view all the answers

    Which adverse effect is most commonly associated with bile acid sequestrants?

    <p>Constipation</p> Signup and view all the answers

    What common side effect is minimized by increasing dietary fiber and fluid intake while using bile acid sequestrants?

    <p>Constipation</p> Signup and view all the answers

    What is the effect of bile acid sequestrants on LDL cholesterol levels over time?

    <p>LDL decline begins during the first week and maximizes within one month</p> Signup and view all the answers

    What is the mechanism of action of ezetimibe?

    <p>Blocks cholesterol absorption in the small intestine</p> Signup and view all the answers

    What precaution should be observed when prescribing rosuvastatin to Asian patients?

    <p>Start with the lowest available dosage and monitor diligently</p> Signup and view all the answers

    What effect can ezetimibe have on HDL cholesterol levels?

    <p>Increase HDL cholesterol by 1% to 4%</p> Signup and view all the answers

    What is a significant risk associated with combining ezetimibe and statins?

    <p>Increased risk for liver damage</p> Signup and view all the answers

    What role does colesevelam play in managing diabetes?

    <p>It helps control hyperglycemia in type 2 diabetes patients</p> Signup and view all the answers

    Why was niacin recommended for removal from guidelines in 2016?

    <p>It does not improve clinical outcomes despite lowering lipid levels</p> Signup and view all the answers

    Which of the following is NOT a known interaction of ezetimibe?

    <p>Beta-blockers</p> Signup and view all the answers

    Which of the following is NOT a reason colesevelam is preferred over older bile acid sequestrants?

    <p>Significantly decreases LDL levels in patients with high VLDL</p> Signup and view all the answers

    Why are fibrates considered third-line drugs for managing lipid disorders?

    <p>They do not reduce mortality from ASCVD</p> Signup and view all the answers

    What is the principal indication for gemfibrozil?

    <p>Hypertriglyceridemia</p> Signup and view all the answers

    Bile acid sequestrants are considered safe as they are:

    <p>Biologically inert and insoluble in water</p> Signup and view all the answers

    What is the first step in monitoring patients on statins?

    <p>Obtain baseline laboratory values for cholesterol and liver function tests</p> Signup and view all the answers

    How much can gemfibrozil decrease VLDL levels based on treatment?

    <p>40% to 55%</p> Signup and view all the answers

    What impact do fibrates have on HDL cholesterol levels?

    <p>Increase HDL cholesterol levels</p> Signup and view all the answers

    In patients with high VLDL levels, bile acid sequestrants may result in:

    <p>Sustained and significant elevation of VLDL levels</p> Signup and view all the answers

    Which of the following is an adverse effect that has been reported with ezetimibe?

    <p>Myopathy</p> Signup and view all the answers

    Which of the following measures is used to evaluate therapeutic effects of statins?

    <p>Decrease in LDL and increase in HDL levels</p> Signup and view all the answers

    An important consideration when taking bile acid sequestrants is:

    <p>Increased dietary fiber and fluids is recommended to minimize constipation</p> Signup and view all the answers

    What is the recommended timing for administering ezetimibe relative to bile acid sequestrants?

    <p>1 hour before or 4 hours after</p> Signup and view all the answers

    Which of the following substances can gemfibrozil NOT effectively lower?

    <p>LDL cholesterol</p> Signup and view all the answers

    What is an important contraindication for the use of statins?

    <p>Pregnant women</p> Signup and view all the answers

    What should patients taking statins report to their provider?

    <p>Muscle pain or tenderness</p> Signup and view all the answers

    What is the primary therapeutic use of gemfibrozil?

    <p>To reduce elevated levels of plasma triglycerides</p> Signup and view all the answers

    What should patients taking gemfibrozil be advised to report?

    <p>Muscle tenderness or weakness</p> Signup and view all the answers

    Which of the following conditions contraindicates the use of gemfibrozil?

    <p>Gallbladder disease</p> Signup and view all the answers

    Gemfibrozil can increase the risk of which adverse effect due to its mechanism of action?

    <p>Gallstones</p> Signup and view all the answers

    What is the likely reason for gemfibrozil's benefits in patients with normal LDL cholesterol and low HDL cholesterol?

    <p>Elevation of HDL cholesterol and reduction of TGs</p> Signup and view all the answers

    Which of the following is a recommended monitoring approach for patients on gemfibrozil?

    <p>Periodic tests of blood lipids</p> Signup and view all the answers

    What is the mechanism of action of PCSK9 inhibitors?

    <p>Binding to PCSK9 and preventing it from degrading LDL receptors</p> Signup and view all the answers

    What common adverse effect is associated with the use of PCSK9 inhibitors?

    <p>Hypersensitivity reactions</p> Signup and view all the answers

    What should be monitored in patients taking warfarin in conjunction with gemfibrozil?

    <p>Prothrombin time (international normalized ratio)</p> Signup and view all the answers

    In which of the following scenarios would the combination of a statin with gemfibrozil be most appropriate?

    <p>In patients with normal liver function</p> Signup and view all the answers

    Which lipid class do PCSK9 inhibitors primarily target for reduction?

    <p>Low-density lipoproteins (LDL)</p> Signup and view all the answers

    Which of the following statements regarding gemfibrozil is true?

    <p>It is primarily used when diet modifications are ineffective.</p> Signup and view all the answers

    What factor should be considered when using PCSK9 inhibitors?

    <p>Patient's LDL receptor activity</p> Signup and view all the answers

    Which of the following is TRUE about gemfibrozil's impact on LDL levels?

    <p>It can sometimes increase LDL levels in high triglyceride conditions.</p> Signup and view all the answers

    What is the primary reason for prescribing statins for primary prevention?

    <p>To reduce the risk of cardiovascular events</p> Signup and view all the answers

    Which statin is specifically mentioned as effective for patients with normal LDL levels but increased CV risk?

    <p>Rosuvastatin</p> Signup and view all the answers

    For which group of patients is it recommended to start statins immediately after an MI?

    <p>Patients who did not receive statins prior to the MI</p> Signup and view all the answers

    What is the American Diabetes Association's recommendation regarding statins for patients over 40 years old?

    <p>All patients older than 40 years with LDL over 100 mg/dL should receive a statin</p> Signup and view all the answers

    What is the principal site where statins exert their effects?

    <p>Liver</p> Signup and view all the answers

    Which side effect is commonly associated with the use of statins?

    <p>Muscle aches and tenderness</p> Signup and view all the answers

    What enhanced risk factor is NOT associated with statin-induced myopathy?

    <p>Regular exercise</p> Signup and view all the answers

    How are statins primarily excreted from the body?

    <p>In the bile</p> Signup and view all the answers

    Which of the following statins is metabolized through CYP3A4?

    <p>Atorvastatin</p> Signup and view all the answers

    What is the risk associated with the concurrent use of certain medications that inhibit CYP3A4 in patients taking statins?

    <p>Elevated statin levels in the bloodstream</p> Signup and view all the answers

    What is the incidence rate of fatal rhabdomyolysis associated with statin use?

    <p>Less than 0.15 case per 1 million prescriptions</p> Signup and view all the answers

    Which characteristic symptoms indicate mild statin-induced myopathy?

    <p>Localized muscle weakness and pain</p> Signup and view all the answers

    Why should statin doses be reduced for individuals of Asian heritage?

    <p>They reach higher levels of statins in the bloodstream</p> Signup and view all the answers

    What should be monitored if a patient on statins develops symptoms of myopathy?

    <p>Creatine kinase (CK) levels</p> Signup and view all the answers

    A patient experiences muscle pain while on statins. What initial action should be taken regarding the statin prescription?

    <p>Discontinue the statin and reassess therapy</p> Signup and view all the answers

    What type of cholesterol is most directly related to the risk of developing atherosclerotic cardiovascular disease (ASCVD)?

    <p>Low-density lipoproteins (LDLs)</p> Signup and view all the answers

    What condition is characterized by deposition of fibrous plaque in the arterial wall?

    <p>Atherosclerosis</p> Signup and view all the answers

    Which of the following consequences is primarily associated with severe atherosclerotic cardiovascular disease (ASCVD)?

    <p>Stroke</p> Signup and view all the answers

    What is the primary method for reducing the risk of serious atherosclerotic cardiovascular disease (ASCVD)?

    <p>Reducing LDL cholesterol levels</p> Signup and view all the answers

    What initial manifestation commonly indicates moderate cardiac ASCVD?

    <p>Anginal pain</p> Signup and view all the answers

    What can a ruptured atherosclerotic lesion cause?

    <p>Formation of thrombus that may block distant vessels</p> Signup and view all the answers

    Which demographic is primarily affected by atherosclerotic cardiovascular disease, according to the statistics provided?

    <p>Women</p> Signup and view all the answers

    Which term refers to the initial phase of atherosclerotic cardiovascular disease characterized by fatty streaks?

    <p>Atherogenesis</p> Signup and view all the answers

    What is considered a high ASCVD risk percentage according to the guidelines?

    <p>20%</p> Signup and view all the answers

    Which of the following is NOT a major positive risk factor for ASCVD?

    <p>Young age</p> Signup and view all the answers

    Which scoring instrument is most commonly used to calculate 10-year ASCVD risk?

    <p>Framingham Risk Prediction Score</p> Signup and view all the answers

    What are therapeutic lifestyle changes primarily aimed at improving?

    <p>Diet, exercise, weight control, and smoking cessation</p> Signup and view all the answers

    What is the role of statins in cholesterol management according to the guidelines?

    <p>Used if therapeutic lifestyle changes fail</p> Signup and view all the answers

    How is diabetes classified in relation to ASCVD risk?

    <p>ASCVD risk equivalent</p> Signup and view all the answers

    What is the intended benefit of drug therapy in cholesterol management?

    <p>Primary prevention and slowing ASCVD</p> Signup and view all the answers

    What is the primary method for lowering LDL cholesterol?

    <p>Diet modification and exercise</p> Signup and view all the answers

    What role does cholesterol play in the body?

    <p>It serves as a main component of cell membranes</p> Signup and view all the answers

    What factor should be included when calculating the Framingham Risk Prediction Score?

    <p>Age</p> Signup and view all the answers

    When should drug therapy for high LDL cholesterol be initiated?

    <p>Only after lifestyle changes have been attempted</p> Signup and view all the answers

    Which class of lipoproteins is primarily responsible for delivering triglycerides from the liver?

    <p>Very-low-density lipoproteins (VLDLs)</p> Signup and view all the answers

    What is one example of a drug used to treat high cholesterol?

    <p>Bile acid sequestrants</p> Signup and view all the answers

    What enzyme is a critical catalyst in hepatic cholesterol synthesis?

    <p>3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase)</p> Signup and view all the answers

    What is a key consideration regarding the continued use of LDL cholesterol-lowering drugs?

    <p>LDL levels will return to pretreatment values if stopped</p> Signup and view all the answers

    What effect does an increase in dietary saturated fats have on circulating cholesterol levels?

    <p>It produces a substantial increase in circulating cholesterol levels</p> Signup and view all the answers

    How many categories of patients benefit from statin treatment under the 2018 ACC/AHA guidelines?

    <p>Four</p> Signup and view all the answers

    What is the primary core lipid of low-density lipoproteins (LDLs)?

    <p>Cholesterol</p> Signup and view all the answers

    How do LDL receptors on cells influence cholesterol absorption?

    <p>They help cells bind and uptake LDL particles from the blood</p> Signup and view all the answers

    Why is high HDL cholesterol considered a negative risk factor?

    <p>It is associated with lower ASCVD risk</p> Signup and view all the answers

    What role do lifestyles modifications have in cholesterol management?

    <p>They are considered first-line treatment</p> Signup and view all the answers

    What is the main physiologic role of high-density lipoproteins (HDLs)?

    <p>Carrying cholesterol to the liver for excretion</p> Signup and view all the answers

    What happens when dietary cholesterol intake increases?

    <p>Cholesterol absorption in the intestines decreases</p> Signup and view all the answers

    Which lipoprotein accounts for the majority of cholesterol in the blood?

    <p>Low-density lipoproteins (LDLs)</p> Signup and view all the answers

    What effect does increasing LDL receptor expression have on cholesterol levels?

    <p>Enhances the capacity for LDL uptake, reducing LDL levels in the blood</p> Signup and view all the answers

    Which of the following statements about plasma lipoproteins is correct?

    <p>Apolipoproteins increase the structural stability of lipoproteins.</p> Signup and view all the answers

    What is the primary composition of the hydrophobic core of lipoproteins?

    <p>Cholesterol and triglycerides</p> Signup and view all the answers

    Which class of lipoproteins is primarily involved in the delivery of dietary fats?

    <p>Chylomicrons</p> Signup and view all the answers

    What is the relationship between LDL levels and the risk of ASCVD?

    <p>Lowering LDL levels decreases the risk of ASCVD</p> Signup and view all the answers

    What do high levels of HDL cholesterol do in relation to ASCVD?

    <p>They actively protect against ASCVD</p> Signup and view all the answers

    What process begins when LDLs penetrate the arterial wall?

    <p>An inflammatory response that includes macrophage infiltration</p> Signup and view all the answers

    Which of the following is a consequence of oxidized LDLs?

    <p>Attraction of monocytes into the subendothelial space</p> Signup and view all the answers

    What indicates a mature atherosclerotic lesion?

    <p>Presence of a large lipid core and a tough fibrous cap</p> Signup and view all the answers

    What major risk factor contributes to the development of ASCVD according to the guidelines?

    <p>High levels of LDL cholesterol</p> Signup and view all the answers

    Which of the following correctly describes foam cells?

    <p>They are formed from macrophages that have taken up oxidized LDLs</p> Signup and view all the answers

    What happens when the fibrous cap of an atherosclerotic plaque ruptures?

    <p>Platelet adhesion and potential thrombosis occur</p> Signup and view all the answers

    What lifestyle changes are recommended for high ASCVD risk individuals?

    <p>Regular cholesterol screening and risk assessment</p> Signup and view all the answers

    What is the main goal of using cholesterol-lowering drugs?

    <p>To reduce elevated LDL cholesterol levels</p> Signup and view all the answers

    What is the primary action of statins in patients with atherosclerosis?

    <p>Decrease LDL cholesterol levels</p> Signup and view all the answers

    Which type of cholesterol is referred to as 'bad cholesterol'?

    <p>LDL cholesterol</p> Signup and view all the answers

    What role does the National Cholesterol Education Program (NCEP) serve?

    <p>It provides guidelines for cholesterol detection and management</p> Signup and view all the answers

    How quickly do statins typically show a significant reduction in LDL cholesterol levels?

    <p>Within 2 weeks</p> Signup and view all the answers

    What is one of the non-lipid beneficial cardiovascular actions of statins?

    <p>Reduce plaque cholesterol content</p> Signup and view all the answers

    What effect does reducing LDL cholesterol levels have on the risk for major cardiovascular events?

    <p>It decreases the risk for events by about 1% for each 1% reduction</p> Signup and view all the answers

    Which of the following statements is true about the development of atherosclerosis?

    <p>It involves deposition of lipids and is considered a chronic inflammatory process</p> Signup and view all the answers

    What risks do statins help lower in patients with ASCVD?

    <p>Risk for stroke, MI, and sudden death</p> Signup and view all the answers

    What mechanism do statins employ to lower LDL cholesterol levels?

    <p>Inhibition of HMG-CoA reductase</p> Signup and view all the answers

    What is a characteristic of the HDL cholesterol levels in patients at high risk for ASCVD?

    <p>Should be above 50 mg/dL</p> Signup and view all the answers

    Which of the following adverse effects is a reason for discontinuing statin therapy?

    <p>Muscle damage</p> Signup and view all the answers

    What is the effect on serum cholesterol levels if statin therapy is stopped?

    <p>Cholesterol levels return to pretreatment levels</p> Signup and view all the answers

    Which statin may be approved for primary prevention in specific patients with normal LDL levels?

    <p>Rosuvastatin</p> Signup and view all the answers

    What factor is attributed to the effectiveness of statins in lowering LDL cholesterol in the liver?

    <p>Increased LDL receptor synthesis</p> Signup and view all the answers

    Which of the following is a reason statins might still be effective in patients with normal LDL levels?

    <p>They can help with primary prevention of cardiovascular events</p> Signup and view all the answers

    In terms of dosage, what is a typical reduction of LDL cholesterol after statin therapy?

    <p>Up to 25% with low doses</p> Signup and view all the answers

    What is one potential short-term effect of statin therapy on triglyceride levels?

    <p>Moderate decrease</p> Signup and view all the answers

    Study Notes

    Cholesterol-Lowering Drugs

    • 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.

    • 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.

    • 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

    • 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.

    • Apolipoproteins: Apolipoproteins, the protein component of lipoproteins, act as recognition sites for cell receptors, activating enzymes that metabolize lipoproteins, and enhancing lipoprotein stability.

    • 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").

    • LDL vs. HDL Cholesterol: LDL cholesterol promotes atherosclerosis ("bad cholesterol"), while HDL cholesterol reduces ASCVD risk ("good cholesterol").

    Cholesterol Screening and Management

    • 2018 ACC/AHA Guidelines: Emphasize identifying patients most likely to benefit from cholesterol-lowering drugs (statins) by assessing ASCVD risk (10-year risk).

    • 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).

    • 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

    • Therapeutic Lifestyle Changes (TLCs): These nondrug methods (diet, exercise, weight control, smoking cessation) are the first-line treatment for high cholesterol.

    • Drug Therapy: Employed only when TLCs are insufficient or inadequate.

      • 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.

      • Statin Mechanism: Statins inhibit cholesterol synthesis. This prompts the liver to produce more LDL receptors, removing LDL cholesterol from the blood.

      • Non-lipid benefits: Statins can stabilize atherosclerotic plaques, reduce inflammation, slow calcification, improve vessel dilation, and reduce thrombosis risk.

      • 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).

      • 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.

      • Contraindications: Pregnancy.

      • 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.

      • 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.

      • 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.

      • PCSK9 Inhibitors: Inhibit the protein PCSK9, enabling more cholesterol removal. Administered subcutaneously. Possible adverse effects include hypersensitivity reactions and antibody formation.

    • 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.

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