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Cholesterol (What to do before and during statin therapy? (Baseline:
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Cholesterol
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Path:
2 types of cholesterol
- LDL : liver to periphery, too much causes plaques (vascular disease)
- HDL: excess cholesterol to liver
Recommendations for cholesterol
- LSM (diet exercise)
- (Pretest FM) Exercise is best for LDL
- :no_smoking: best for HDL
- Adherence to LSM or meds
Who specifically gets statin?
- anyone w/ vascular disease
- anyone w/ high LDL ≥190
:pencil2:Vasc disease is MI, CVA, PVD, Carotid Stenosis (CS)
- Low-ish LDL 70-189
- +age (40-75y)
- +diabetes :candy:
- Lowi-ish LDL 70-189
- +age (40-75y)
- +calculated risk high
Calculator accounts for
- HTN
- obesity
- smoking :smoking:
- age >45 :male_sign: / >55y :female_sign:
- Family Hx
Tx: :stars:Goal is always High intensity Statin
- atorvastatin(Lipitor) 40-80mg
- rosuvastatin(Crestor) 20-40mg
- others (many)
IF they can't be on High intensity go to moderate intensity
reasons:
- age > 75
- statin intolerance
- other comorbid diseases w/ drug drug interactions (Renal disease)
Moderate intensity
- atorvastatin 10-20mg
- rosuvastatin 5-10mg
- simvastatin
- pravastatin
- lovastatin
Low intensity
- simvasatin
- pravasatin
- lovastatin
Who doesn't get a statin?
WTF even is the "goal"? (Pretest FM)
- For patients with known CAD or diabetes,
- If a patient has no known coronary disease,
- estimated using National Cholesterol Education Program (NCEP) risk calculator
- If the 10-year risk ≥ 20%,
- If the risk is between 10% and 20%,
- If the risk is less than 10%,
- management has changed from "controlling cholesterol" to "get them on statin"
- who gets statin, who shouldn't, when things go wrong
- review of other meds to control cholesterol when statins don't work
- Statin therapy is population based recommendations, tailor your statin therapy to your patient
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