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What are the 5 major risk factors for Coronary Heart Disease?
- Cigarette smoking
- Hypertension (blood pressure >= 140/90 mmHg or on meds)
- Older age (Men>= 45; women >=55)
- Low HDL cholesterol (<40 mg/dL)
- Elder (family) hx of premature coronary artery disease (male first degree relative <55 y; female first degree relative <65)
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What are the ranges for a normal, borderline high, and high Total Cholesterol level?
- Normal <200 mg/dL
- Borderline High 200-239 mg/dL
- High 240 mg/dL
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What are the ranges for a normal, borderline high, high and very high Triglycerides?
- Normal <150 mg/dL
- Borderline high 150-199 mg/dL
- High 200-499 mg/dL
- Very high >500 mg/dL
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What are the ranges for a low, normal, and high HDL Cholesterol?
- Low <40 mg/dL Men, <50 mg/dL Women
- Normal 40-50 mg/dL Men, 50-59 mg/dL Women
- High 60 mg/dL Men and Women (negative risk factor)
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What is a negative risk factor for Coronary Heart disease?
HDL >= 60 mg/dL
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What are the risk factors for hyperlipidemia - LDL?
- Dietary factors (targeting)
- Genetic factors
- Secondary to:
- Diseases- Nephrotic syndrome (renal disease)
- Medications- Antipsychotic medications
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What are the risk factors for hyperlipidemia - Triglycerides?
- Obesity
- Physical inactivity
- Other
- Genetic factors
- Dietary (high carb intake)
- Diseases - Type 2 Diabetes
- Medications - Protease inhibitors
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What are the risk factors for hyperlipidemia - HDL?
- Obesity
- Physical inactivity
- OtherGenetic disorders
- Dietary (high carb intake)
- Diseases - Type 2 diabetes
- Medications - Anabolic steroids
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What is the target LDL for low risk (0-1 risk factors)?
<160 mg/dL
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What is the target LDL for moderate risk (>=2 risk factors)?
<130 mg/dL
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What is the target LDL for high risk (CAD, CAD equivalent, 10y risk >20%)?
<100 mg/dL
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What are some therapeutic lifestyle changes to target LDL?
- Restrict total fat intake to 25-35% of total calories
- Restrict saturated fat to <7% of total calories
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What medication can you take to target LDL?
Statins
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What are some therapeutic lifestyle changes to target triglycerides?
Weight loss can decrease triglyceride levels by 22%
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What are some medications to take to target triglycerides?
Fibrates (lower triglycerides 50%)
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When should you treat triglycerides?
If levels are >500 mg/dL (concern for pancreatitis)
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What is the primary target for therapy when treating hyperlipidemia?
LDL cholesterol (major atherogenic lipoprotein)
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What are some therapeutic lifestyle changes that will increase HDL?
Exercise can increase HDL by 1-4 mg/dL, depending on intensity of activity
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What is the tx plan if you have clinical atherosclerotic CVD (MI, angina, coronary revascularization, stroke, TIA, peripheral arterial disease)?
High intensity statin therapy
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What is high intensity statin therapy?
Daily dose lowers LDL cholesterol level by >=50% on average
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What is recommended when giving high intensity statin therapy?
- Atorvastatn 40-80 mg
- Rosuvastatin 20-40 mg
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What is moderate intensity statin therapy?
Daily dose lowers LDL cholesterol level by 30 - <50% on average
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What is recommended when giving moderate intensity statin therapy?
- Lower dosage of Atorvastatin and Rosuvastatin
- Generic drugs
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What do you do when a pt comes in who has Diabetes and is between 40-75 yr and has an LDL level between 70-189 mg/dL?
- Calculate 10 yr risk of atherosclerotic CVD
- If risk <7.5% = moderate intensity statin
- If risk >7.5% = high intensity statin
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What do you do when a pt comes in who has no diabetes and is between 40-75 yr and has an LDL level between 70-189 mg/dL?
- Calculate 10 yr risk of atherosclerotic CVD
- If risk >=7.5%, mod-to-high intensity statin therapy
- Under 7.5% = no statins
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What do you do when a pt comes in who has LDL cholesterol level of >=190 mg/dL?
High intensity statin therapy
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