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CC January 2018 Hypertriglyceridemia

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echoecho's version from 2018-04-16 05:18

Section

Question Answer
A serum triglyceride (TG) level < ___ mg/do is considered normal?150
There are two commonly used hypertriglyceridemia classifications, name these two?1) ATP /NCEP (Adult treatment Panel of the National Choleterol Education Program 2) Endocrine society
List the ATP/NCEP classification normals, borderline high, high, very high?1) normal = < 150 mg/dL. 2)borderline high = 150-199 mg/dL; 3) High = 200-499 mg/dL 4) very high = > 500 mg/dL
List the Endocrine Society classification normals, mild, moderate, severe, very severe?1) normal = < 150 mg/dL 2) mild 150-199 mg/dL 3) moderate =200-999 mg/dL. 4) severe = 1000-1999 mg/dL 5) very severe = > 2000 mg/dL
While re thee is an assoc of elevated TG w/ the risk of CVD, whether the relationship is ____ or note has been a matter of debate?causal
*** A 2017 guideline review stated that "observational, randomized, clinical and genetic studies all support the ________ relationship between TG and CVD?causal
The risk of CVD associated with LDL-cholesterol elevation is much stronger than for TG elevation, which why cholesterol is targeted in both primary and _____ prevention?secondary
Hypertriglyceridemia is a characteristic of metabolic syndrome which is associated with an increased risk of _____?CVD
*** Severe hypertriglyceridemia is also a cause of acute ________? Hypertriglyceridemia is the 3rd leading cause of acute pancreatitis (after ______ and _____) and accounts for ___% of cases?1) pancreatitis 2) alcohol. 3)gallstones 4) 4%
There is a direct correlation between TG elevation and increased pancreatitis risk - a ___% increase in risk with every 100 mg/dL increase in TG?4
Generally, pancreatitis occurs in patients with TG levels > _____ mg/dL? In a retrospective study, ___% of individuals with this level of elevation had a hx of acute pancreatitis?1) > 1000. 2) 20%
Hypertriglyceridemia may be genetic in origin. Give some examples?1) chylomicronemia 2) familial hypertriglyceridemia 3) familial dysbetalipoproteinemia
Hypertriglyceridemia may be SECONDARY to other conditions and teatments. List these? 1) DM 2) hypothyroidism 3) obesity 4) nephrotic syndrome 5) pregnancy as levels double in 3rd trimester 6) alcohol 7) high carbohydrate diet 8) bile acid sequestrants 9) beta-blockers 10) estrogen (oral) 11) glucocorticoids 12) atypical antipsychotics 13) immunosuppressants (cyclosporine) 14) retinoids 15) protease inhibitors (especially ritonavir) 16) tamoxifen (Nolvadex) 17) thiazides diuretics
*** Initial mgmt of individuals with hypertriglyceridemia includes what modifications (even though these changes are unlikely to result in major reduction if TG levels are very high as > 1000 mg/dL?lifestyle and dietary modifications
List the 3 modifications?1) dietary (for pets w/ moderate hypertriglyceridemia, reduce caloric and carbohydrate intake (esp refined carbs), reduce alcohol intake, eliminate trans fats and increase intake of omega-3 products. For patients with TG levels > 800-1000 mg/DL, dietary fat intake should be markedly restricted 2) weight loss (5-10% reduction in body weight) 3) exercise (moderate aerobic exercise)
For those with severe elevations as TG > 1000 mg/dL, what is the modification?total elimination of alcohol and reduction of total fat to 10-15% of daily caloric intake
List the 4 classes that lower TG levels?1) statins 2) fibrates 3) niacin 4) omega-3 fatty acids
Drug therapy is usually initiated if TG levels remain high (above ______ mg/dL) despite lifestyle modifications?886 mg/dL
Statins decrease cholesterol synthesis, lower TG levels and decrease risk of CVD. Average TG reduction is ?, but high-intensity statin (atorvastatin ____mg/day or Rosuvastatin ____ mg/day) can reduce TG levels by about 40%?10-33%; 80; 20
Fibrates act by doing what and can lower TG levels by ___% making them first-line therapy for markedly elevated levels?regulating various steps in lipid metabolism; 53%
With fibrates, what is the adverse effect with the risk increasing with concomitant statin therapy?muscle toxicity
With fibrates, the muscle toxicity risk is lower with what medications? Fenofibrate (Tricor) compared to Gemfibrozil (Lopid)
Other adverse effects are ____(5%) and ____ ____ (2%)?GI; skin rash
memorize
Fibrates can interfere with Warfarin metabolism, so a warfarin dose reduction of ___% is recommended with concomitant use
Niacin can reduce TG levels by ___-___% but is rarely used because of adverse effects, name these? As well as lack of proven CVD risk reduction? :15-25%; flushing, liver toxicity, gastrointestinal distress
Question Answer
Omega-3 fatty acids can lower TG levels by?23-45%
Omega-3 fatty acids are available OTC but prescription formulations are more potent, name these?1) Lovasa 2) Vascepa 3) Epanova
What are the GI side effects of omega 3 fatty acids?1) gastrointestinal side effects 2) LDL elevation
There are few significant drug interactions with omega-3 fatty acids, however there is an antithrombotic effect when > ____ g/day are consumed, so care must be taken with concomitant use high-dose omega-3 fatty acids and other medications that increase bleeding risk?3
Recommendations to lower TG levels to decrease the risk of pancreatitis, although the threshold varies (____ - _____ mg/dL)?500; 1000
Do calcium channel blockers, testosterone and ACEI increase TG levels?no
Cigarette smoking has a minor effect in raising TG, however it affects the HDL/LDL ratio, true or false?true
What are the recommendations by the American Heart Association (2011) in treatment of hypertriglyceridemia?1) goal is to lower to reduce risk of pancreatitis and CVD but no goal given 2) 200-499 mg/dL = lifestyle modifications. If > 500 mg/dL, intensive lifestyle modification and tgl-lowering medication
What are the recommendations by the National LIpid Association (2015) in treatment of hypertriglyceridemia?1) goal is to lower to < 500 mg/dL to reduce pancreatitis risk; the control non-HDL and LDL cholesterol based on risk. 2) 200-499 mg/dL - lifestyle modification plus statin based on cardiovascular risk. If > 500-999 mg/dL = lifestyle modification plus triglyceride-lowering medication or a statin if no hx of pancreatitis. If > 1000 mg/dL = intensive lifestyle modification and tgl-lowering medication
What are the recommendations by the Endocrine Society (2012) in treatment of hypertriglyceridemia?1) goal is to lower to < 1000 mg/dL to reduce pancreatitis risk, then target non-HDL based on risk 2) If 200-999 mg/dL = lifestyle modification and consideration of a triglyceride-lowering medication alone or in combination with a statin. If > 1000 mg/dL = intensive lifestyle modification and triglyceride-lowering medication (fibrates as first line)
What are the recommendations by the European Sociaty of Cardiology / European Atherosclerosis Society (2017)?1) goal is to lower to < 880 mg/dL to reduce pancreatitis risk, then target LDL cholesterol based on risk 2) > 200 mg/dL = drug treatment should be considered in high-risk patients. Statins may be considered first-line treatment for reducing CVD risk in high-risk patients with moderate triglyceride elevation. High-risk patients with levels > 200 mg/dL despite statin treatment should be considered for fibrate treatment
*** SUMMARY = Is hypertriglyceridemia an independent risk factor for cardiovascular disease?yes
*** SUMMARY = severe Hypertriglyceridemia increases the risk of what condition?pancreatitis
*** SUMMARY = Can hypertriglyceridemia be inherited? Acquired?yes; yes
*** SUMMARY = Initial therapy for hypertriglyceridemia is what?lifestyle modification with dietary changes, increased exercise and weight loss
*** SUMMARY = What medications are the most effective medications to decrease triglyceride levels?fibrates
memorize