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Dyslipidemia - Coggle Diagram
Dyslipidemia
Treatment
Statin Therapy
HMG-CoA reductase inhibitor
Low
<30%
Pravastatin 10-20mg
Lovastatin 20mg
not first line
High
LDL-C reduction >50%
Rosuvastatin 20-40mg
avoid in higher risk
rhabdomylosis
75y and older
impaired renal function
frailty
multiple co-morbidities w fibrates
Atorvastatin 40-80mg
Moderate
30-49%
Rosuvastatin 5-10mg
Crestor
Simvastatin 20-40mg
Zocor
Pravastatin 40-80mg
Lovastatin 40mg
Atorvastatin 10-20mg
Lipitor
not advised
Niacin
Resin
Caution
check hepatic enzymes prior to initiation for baseline
Concomitnant use of grapefruit juice: simvastatin, atorvastatin, lorvastatin
Adverse effects:
Rhabdomyolysis
Myositis
Selective Cholesterol absorption inhibitor
Ezetimibe (Zetia)
Adverse effects:
Few d/t limited systemic absorption
(+) simvastin = Vytorin
Decrease. LCL-C 20%
Proprotein convertase subtilisin/kexin type 9 (PCSK9) Inhibitors
monoclonal antibody derived = expensive
Evolocumab (Repatha)
Alirocumab (Praluent)
Decrease LDL-C >60%, add on to statin therapy
ACL (adenosine triphosphate citrate lyase) inhibitors (non-statin)
Bempedoic (Nexletol)
Decrease LDL-C by 33%
add or or instead of statin-intolerant patients
Screening
Lipoprotein profile
TC - Total cholesterol
LDL-C (Low density lipoprotein cholesterol)
HDL- (High density lipoprotein cholesterol)
TG (Triglycerides)
Repeat profile if TG >400mg/dL
Esp w cardiovascular risk
DM
HTN
Fam hx dyslipidemia
Obesity
Primary Prevention
LDL >190 mg/dL
high intensity statin
Age 40-75
DM
Moderate intensity statin
20% "high risk"
Initiate statin to reduce LDL-C >50%
Triglyceride-lowering
Omega-3 fatty acid
4g/d
decreases 30%
Fibric acid derivatives (fibrates)
decrease 50%