Therapy II exam 1

What is the leading cause of death for people in the US?

Heart disease

CV diseases causes of death

Coronary heart disease ~1/2

Stroke ~16%

Heart failure ~7%

CVD Risk Factors

Major: HTN, DM, High-inflammatory conditions(RA, lupus)

Smoking, dyslipidemia, CKD, obesity, inactivity, age

How many adults have HTN?

~1 in 2 adults (120 million Americans)

What ages groups is HTN more prevalent in?

Older adults 55+

What race is disproportionately susceptible to HTN

African American/Black

What increases afterload?

Hyptertension and vasoconstriction. Increased afterload increases cardiac workload

What is goal BP and what guidelines?

<120 and <80 (American Heart Association)

Is HTN a disease?

No. HTN is an asymptomatic risk factor

What is elevated BP?

120-129 and <80

What is stage 1 HTN?

130-130 or 80-89

What is stage 2 HTN?

>140 or >90

Primary HTN

expected normal HTN from age or other standard factors

Secondary HTN

Unexpected unusual HTN.

What causes 2ndary HTN

30% Renal disease

25% Primary aldosteronism

25% Obstructive sleep apnea

5% Drug or alcohol induced

What should be done for all cases of secondary HTN regardless of if hypokalemia is present?

Screening for aldosteronism

Dyslipidemias

Increased LDL, Decreased HDL, Increased TG, Increased Lp(a)

What is linked to dyslipidemias?

CV diseases, pancreatitis, xanthomas

Cholesterol precursor for

Cell membrane synthesis, steroid hormones, bile acids

What percent of Cholesterol is obtained from food?

~20%

What is the rate limiting step in cholesterol synthesis?

HMG-CoA —> Mevalonate

What do statins act on?

HMG-CoA reductase

What are the lipoproteins?

HDL, LDL, VLDL, Chylomicrons

What is the bad cholesterol, what does it do?

LDL-C, transports cholesterol to peripheral cells from liver

What is the primary target of cholesterol lowering therapy?

LDL-C

What is good cholesterol? Is it always good?

HDL-C, some HDL is functional and some non functional

What are normal HDL levels?

>40mg/dl Men
>50mg/dl Woman

What to know about VLDL-C

Formed in the liver
TG rich in fasting state
VLDL-C = TG/5
Forms VLDL remnant and LDL

What do chlyomicrons do?

Chylomicrons are TG rich lipoproteins that transport fatty acids and cholesterol from the intestines to the liver. They clear from the bloodstream within 12 hours.

What are the classifcations of TG levels?

Normal - <150mg/dl
Borderline high - 150-199 mg/dl

high - >200-499 mg/dl

very high - >500 mg/dl

What are you more at risk for as TGs increase?

Increased risk for pancreatitis

What is the Fredrickson-Friedwald formula?

LDL = TC - (HDL + TG/5)
Typically take average of 2 measurements

When is the Fredrickson formula not valid?

When TG > 400 or patient has not fasted 9-12 hours.

Traditional CHD Risk factors

Age (Male 45+, Female 55+)
Family history premature CHD (<55 in father, <65 in mother or first degree relatives of matching gender)
Low HDL (<40 or <50)
Cigarette smoking, HTN/BP meds, diabetes, obesity

Risk enhancers

History premature ASCVD in parent or sibling 55 men 65 woman
Higher risk ancestry (South asian, Filipino)
High polygenic risk
Chronic inflammatory disease (RA)
Lp(a) >125 nmol/L or >50 mg/dL

hsCRP > 2 mg/L on >1 occasion

TG persistenly above or equal to 175 mg/dL if nonfasting, or 150 mg/dL if fasting

CKM syndrome

Persistent raised LDL equal or above 160-189 or non HDL 190-219

Reproductive risk markers (premature menopause)

What is C-Reactive protein (CRP)?

Inflammatory marker and indpedent risk for vascular events

What are the ACC/AHA guidelines for ASCVD Risk for CRP

<1mg/L = low risk

1-3mg/L = moderate risk

>3mg/L = high risk

What would CRP greater than 10 and greater than 100mg/L be caused by?

Commonly due to systemic infections and trauma

How is elevated CRP treated?

Non-pharm healthy living or initiating or intensifying statin therapy

What is Lp(a)?

Specialized form: glycoprotein/LDL-C complex

What should you know about Lp(a)

It increases risk of CHD

Very important if there is family history of CHD

Normal is <30mg/dL or <75 nmol/L

Should be checked once in a lifetime.

How is elevated Lp(a) treated?

PCSK9-I

Investigational agents

Niacin

Estrogens