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CC July 2017 Lipid treatment in the Elderly

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echoecho's version from 2018-04-25 13:57

Section

Question Answer
What disease is the most common cause of mortality in the geriatric population?CVD
List the prevention approach against what?Addressing modifiable risk factors (HTN, tobacco abuse, physical inactivity, DM, dyslipidemia)
In the Systolic HTN in the Elderly Program (SHEP) trial, elevations of what levels were associated w/ an increased risk of CAD in those whose average age was 72 years?Total cholesterol
What medication is the treatment for dyslipidemia?HMG-CoA reductase inhibitors (statins)
A 2008 meta-analysis involving 19,000 patients (65-82 yrs) was conducted to study the effects of statin use on the elderly for CVD prevention, what were the findings?Statin use was assoc'd w/ decreases in all-cause mortality, coronary artery disease, non-fatal myocardial infarction, need for coronary revascularization and stroke
A 2013 meta-analysis reviewing primary prevention in the elderly was assoc'd w/ a decreased risk of what 2 conditions, but mortality was not affected?1) stroke 2) MI
Due to the higher overall prevalence of CAD in the elderly, statins may have more of a clinical benefits than in the younger patient, yet why are the elderly patients less likely to receive them?1) due to a perceived increased risk of side effects 2) desire to prevent polypharmacy 3) concerns about decreased efficacy due to reduced life expectancy
The 2016 guidelines written by the USPSTF regarding the use of statins for PRIMARY PREVENTION of CVD states what 3 criteria be met?1) age 40-75 2) presence of one or more risk factors such as dyslipidemia, DM, HTN, or smoking 3) a calculated 10 year CVD risk of > 10%
A smaller benefit exists if the calculated risk is ___% to ___%, and the patient may be offered a statin?7.5%; 10%
Statins should be offered if the LDL level is above _____ mg/dL or the patient has what known disease regardless of the above criteria?190; familial hypercholesterolemia
The 2013 American Heart Association / American College of Cardiology (AHA / ACC) guidelines on the treatment of high cholesterol used 4 categories to determine whether pets should receive statin therapy, list these 4?1) patients w/ any form of clinical ASCVD 2) patients w/ primary LDL levels of > 190 3) patients w/ DM, 40-75 years of age, with LDL levels 70-189 4) patients w/o DM, 40-75 years of age, with an estimated 10-ear ASCVD risk > 7.5%
For patients over the age of 75,, the 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 are less _____ in this age group?Data
*** If a patient has been taking a statin for secondary prevention and tolerating it, is it reasonable to continue a moderate statin in this age group?Yes
List the moderate dose statin therapy guidelines?1) Atorvastatin (Lipitor) 10-20 mg daily 2) Fluvastatin (Lescol) 40 mg daily 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 vs. sufficient) evidence to recommend statins for PRIMARY prevention in patients over age 75. There is no available evidence to support statin therapy in patients > 85 y.o.?Insufficient
*** SUMMARY = Data on the use of statins in patients over age ____ are limited?75
*** SUMMARY = What should be considered in a patient' when considering statin therapy in older patients?Life expectancy
*** SUMMARY = List the issues that should be included in the discussion between physician and patient about statin use in this population?1) cardiac risk 2) cognitive impairment 3) polypharmacy 4) medication interactions 5) medication adherence 6) medication cost 7) patient preference
*** SUMMARY = The USPSTF recommends statin therapy for primary prevent of CVD when what criteria are met?1) age 40-75 2) risk factors present 3) 10 year CVD risk of > 10%
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