Management of Dyslipidemia and Lipid Therapeutics

Vocabulary practice flashcards covering lipid pathophysiology, 2026 ACC/AHA guidelines, ASCVD risk stratification, statin pharmacology, nonstatin therapeutics, hypertriglyceridemia management, and lipid target goals.

PREVENT Equations

The 10-year ASCVD risk estimation tool utilized in the 2026 ACC/AHA guidelines, featuring lower risk categories: Low (

CPR Framework

A three-step risk evaluation model standing for Calculate (estimate 10-year risk using PREVENT), Personalize (evaluate risk-enhancing factors), Reclassify/Reassess (consider Coronary Artery Calcium scoring if treatment is uncertain), and Decide/Treat.

Apolipoprotein B (apoB)

A structural apolipoprotein present as exactly one molecule per atherogenic particle (LDL, VLDL, IDL, remnants, and Lp(a)) that measures particle concentration directly without requiring a fasting blood sample.

Non-HDL-Cholesterol (non-HDL-C)

Calculated as Total Cholesterol minus HDL-C ($\text{TC} - \text{HDL-C}$), which measures the cholesterol content of all atherogenic particles and has a target threshold always $30\text{ }mg/dL$ higher than the corresponding LDL-C goal.

Coronary Artery Calcium (CAC) Score

A decision-refinement imaging tool where a score of 0 indicates very low risk (allowing statin deferral except in high-risk conditions), while a score $\neq 300$ carries risk comparable to established CVD, shifting goals to $LDL-C < 55\text{ }mg/dL$.

High-Intensity Statin Therapy

Statin regimens designed to lower LDL-C by \neq 50\text{\text{%}} from baseline, specifically Atorvastatin $40\text{ to }80\text{ }mg$ daily or Rosuvastatin $20\text{ to }40\text{ }mg$ daily.

Moderate-Intensity Statin Therapy

Statin regimens designed to lower LDL-C by 30\text{\text{%}} to 49\text{\text{%}} from baseline, including Atorvastatin $10\text{ to }20\text{ }mg$, Rosuvastatin $5\text{ to }10\text{ }mg$, Simvastatin $20\text{ to }40\text{ }mg$, Pravastatin $40\text{ to }80\text{ }mg$, Lovastatin $40\text{ }mg$, Fluvastatin XL $80\text{ }mg$, or Pitavastatin $2\text{ to }4\text{ }mg$.

Hydrophilic Statins

Statins including Rosuvastatin and Pravastatin that exhibit lower muscle penetration and do not rely on extensive CYP3A4 metabolism, reducing the risk of drug-drug interactions.

Statin-Associated Muscle Symptoms (SAMS)

Subjective muscle complaints reported by roughly 10\text{\text{%}} of patients on statins in clinical practice, though true statin-attributable excess symptoms occur in only \text{\text{}}1\text{\text{%}} over placebo due to the nocebo effect.

SLAP Strategy

A systematic clinical approach for managing statin intolerance: Switch statin, Lower dose, Alternate-day dosing, and Polypharmacy (adding nonstatin agents like ezetimibe or PCSK9 inhibitors).

Simvastatin Drug Interaction Dose Caps

Mandatory dosing limits for simvastatin due to CYP3A4-mediated interaction risks: capped at $10\text{ }mg$ daily with verapamil, diltiazem, or dronedarone; and capped at $20\text{ }mg$ daily with amiodarone, amlodipine, or ranolazine.

Ezetimibe

An oral cholesterol absorption inhibitor that blocks the NPC1L1 transporter in the intestine, reducing LDL-C by \text{\text{}}18\text{\text{%}} as monotherapy and providing an additional \text{\text{}}25\text{\text{%}} lowering when combined with a statin.

PCSK9 Monoclonal Antibodies

Injectable monoclonal antibodies (Alirocumab and Evolocumab) that bind extracellular PCSK9 to prevent LDL receptor degradation and enhance hepatic receptor recycling, lowering LDL-C by 45\text{\text{%}} to 64\text{\text{%}}.

Inclisiran

A GalNAc-targeted small interfering RNA (siRNA) administered subcutaneously on Day 1, Month 3, and then every 6 months that cleaves PCSK9 mRNA inside hepatocytes to reduce LDL-C by \text{\text{}}48\text{\text{%}} to 52\text{\text{%}}.

Bempedoic Acid

An oral prodrug activated by hepatic ACSVL1 that inhibits ATP citrate lyase upstream of HMG-CoA reductase to provide muscle-sparing LDL-C lowering (17\text{\text{%}} to 24\text{\text{%}}), with safety warnings for hyperuricemia, gout, and tendon rupture.

Enlicitide

The first oral macrocyclic peptide PCSK9 inhibitor taken at $20\text{ }mg$ PO daily on an empty stomach with water, black coffee, or tea at least 30 minutes before food, reducing LDL-C by \text{\text{}}57\text{\text{%}} to 58\text{\text{%}}.

Bile Acid Sequestrants (BAS)

Non-absorbed anion-exchange resins (Colesevelam, Cholestyramine, Colestipol) that bind intestinal bile acids to lower LDL-C by 10\text{\text{%}} to 27\text{\text{%}}; useful in pregnancy and children, but prone to increasing triglycerides and binding co-administered medications.

Lomitapide

An oral microsomal triglyceride transfer protein (MTP) inhibitor approved strictly for Homozygous Familial Hypercholesterolemia (HoFH) that prevents apoB lipoprotein assembly, restricted by a REMS program due to risk of hepatotoxicity and hepatic steatosis.

Evinacumab

An intravenous monoclonal antibody targeting ANGPTL3 administered at $15\text{ }mg/kg$ monthly for HoFH that lowers LDL-C by \text{\text{}}47\text{\text{%}} through a mechanism independent of the LDL receptor.

Very High-Risk ASCVD

Secondary prevention classification defined by $\neq 2$ Major ASCVD Events (Pattern #1) OR $1$ Major ASCVD Event plus $\neq 2$ High-Risk Conditions (Pattern #2), targeting absolute lipid goals of $LDL-C < 55\text{ }mg/dL$ and $\text{non-HDL-C} < 85\text{ }mg/dL$.

Big Four Major ASCVD Events

The four major clinical events used in ASCVD risk stratification: Recent Acute Coronary Syndrome ($<12$ months), Prior Myocardial Infarction, Ischemic Stroke, and Symptomatic Peripheral Artery Disease.

Gemfibrozil and Statin Contraindication

A major drug interaction where gemfibrozil inhibits statin metabolism and OATP1B1 hepatic uptake, leading to elevated statin levels and increased rhabdomyolysis risk; fenofibrate is required if fibrate-statin co-therapy is needed.

Familial Chylomicronemia Syndrome (FCS)

A rare genetic condition characterized by absent lipoprotein lipase (LPL) function and persistent severe hypertriglyceridemia ($TG \neq 1000\text{ }mg/dL$) that responds poorly to standard TG-lowering drugs.

Olezarsen

A GalNAc-conjugated antisense oligonucleotide administered subcutaneously once monthly that degrades APOC3 mRNA to reduce apoC-III levels and improve LPL-independent clearance of triglyceride-rich lipoproteins in FCS.

Icosapent Ethyl (Vascepa)

A prescription purified ethyl ester of eicosapentaenoic acid (EPA) dosed at $4\text{ }g$ daily ($2\text{ }g$ BID with food) that lowers triglycerides without increasing LDL-C and demonstrated a 25\text{\text{%}} relative risk reduction in the REDUCE-IT trial.