BCCP: Primary Prevention

What are ASCVD risk factors (12)

1. LDL> 160

2. TG >175

3. apolipoprotein B >130

4. lipoprotein a >50

5. CRP > 2

6. ABI <0.9

7. metabolic syndrome

8. CKD

9. early menopause or preeclampsia

10. chronic inflammatory (HIV, psoriasis etc)

11. South asian

12. male family history of ASCVD <55yo or females <65yo

Which groups qualify for high intensity statins for primary prevention

20-75 + LDL >190

20-75 + DM + ASCVD risk factors

20-75 + ASCVD risk > 20% (regardless of DM)

Which groups qualify for moderate intensity statins for primary prevention

40-75 + LDL 70 - 189 + DM

40-75 + LDL 70-189 + ASCVD risk 7.5-19%

If a patient is > ___ years old, would not start a statin, but can continue if already on

75

When starting lipid therapy for 20-75 + LDL >190, how do you escalate therapy?

if LDL does not decrease by 50% or is still >100mg/dL, add ezetimibe (should already be on high intensity)

If LDL is still >100 after ezetimibe, add PCSK9i

What are the low intensity statins and how much do they decrease LDL?

decrease 30%

simvastatin 5-10mg

lovastatin 10-20mg

fluvastatin 20-40mg

What are the high intensity statins and how much do they decrease LDL?

decrease 50%

rosuvastatin 20-40mg

atorvastatin 40-80mg

ezetimibe/simvastatin 10/20-40mg

Lowering NaCl intake to < ____mg decreases BP

1500

Potassium intake goal to reduce risk of ASCVD

1380mg (increase to 3500- 5000mg if overweight)

What is first and second line therapy for smoking cessation?

1. varenicline + nicotine replacement (up to 35d before quit date)

2. buproprion (1-2w before quit date)

can start both

For smoking cessation, when should you start with the 21mg patch vs 14mg patch

21mg if you smoke more than 10 cig per day

14mg if you smoke less than 10 cig per day

general weight loss goal

5-10% of body weight in 6 months

Who qualifies for weight loss meds?

<5% weight loss in 6m

BMI >30

BMI 27-29 + 1 ASCVD risk factor

What weight loss med should be avoided in patients with HTN

phentiramine

What weight loss meds are best in T2DM

SGLT2-i or GLP1 agonist

What weight loss drugs should be avoided in patients with a seizure history

phentiramine

naloxone/bupropion

What weight loss meds could help someone that also has depression

phentiramine ± topiramate

orlistat

If a patient has DM + high risk of ASCVD or CKD, initial weight loss therapy should include ____

GLP1 or SGLT2i

Who should be given ASA as primary prevention

40-59yo + ASCVD >10% + no bleed risk

40-59yo + DM + ASCVD risk factors and no bleed risk

benefit is small, do not give if there is any increased risk of bleeding no matter the ASCVD score

Who should recieved omega-3 fatty acids for primary ASCVD prevention

TG 145-499