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CC July 2017 Lipid Therapy in the Elderly

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echoecho's version from 2017-09-05 18:18

Section

Question Answer
What is the most common cause of mortality in geriatric patients?CVD (cardiovascular disease)
SHEP (systolic HTN in the elderly program) trial showed what regarding elevations of total cholesterol levels was assoc'd with increased risk of CAD in patients whose average age was ___ years of age?72
2008 meta-analysis (19,000 patients aged 65-82 years) showed?decreases in all-cause mortality, coronary artery disease, non-fatal MI, need for Coronary revascularization and stroke
2013 meta-analysis reviewing primary prevention in the elderly was associated with?decreased risk of stroke and MI but mortality was not affected
2016 guideline written by USPSTF regarding use of statins for primary prevention of CVD stated that all of what criteria must be met?1) age 40-75 2) presence of one or more risk fiactors such as dyslipidemia, DM, HTN, or smoking 3) calculated 10 year CVD risk of > 10%
Small benefit exists if calculated risk is ___ to___% and put maybe offered a statin?7.5 - 10%
Statins should be offered if the LDL is > ____ or if the patient has known _____ ______ regardless of the above criteria?190; familial hypercholesterolemia
2013 AHA/ACC guidelines on treatment of high cholesterol used what 4 categories to determine if patient should receive statin therapy?1) patients w/ any form of clinical ASCVD 2) patients with primary LDL level of > 190 3) patients with DM, 40-75 y.o., with LDL of 70-189 4) patients w/o diabetes, 40-75 y.o with an estimated 10-year ASCVD risk > 7.5%
For patients > 75, AHA/ACC guidelines notes that while older patients are more likely to benefit from statins than younger patients due to a higher prevalence of CAD, there is less data in this age group, what are their recommendations?if a patient has been taking a statin for secondary prevention and tolerating it, it is reasonable to continue a moderate dose statin in this age group
List the moderate dose statin therapy available?1) Atorvastatin (Lipitor) 10-20 mg daily 2) Fluvastatin (Lescol) 40 mg BID 3) Lovastatin (Mevacor) 40 mg daily 4) Pitavastatin (Livalo) 2-4 mg daily 5) Pravastatin (Pravachol) 40-80 mg daily 6) Rosuvastatin (Crestor) 5-10 mg daily 7) Simvastatin (Zocor) 20-40 mg daily
*** The USPSTF recommendation on statin therapy concluded that there is insufficient evidence to recommend statins for primary prevention in patients > ____. There is no available evidence to support statin therapy in patients over the age of____?75; 85
*** SUMMARY = Data on the use of statins in patients over age ____ are limited?75
*** SUMMARY = What should be considered when considering statin therapy in older patients?patient's life expectancy
*** SUMMARY = List the issues that should be included in the discussion between physician and patient about statin use in this elderly population?cardiac risk, cognitive impairment, polypharmacy, medication interactions, adherence, cost and patient preference
***SUMMARY = The USPSTF recommends statin therapy for primary prevention of CVD when what criteria are met?1) age 40-75 2) risk factor(s) present 3) 10 year CVD risk of 10% or more
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