Management of Cholesterol
Questions and answers
1. What is the 1st line treatment for hyperlipidemia in all patients without contraindications?: Statin
therapy
2. What roles do statins play in the body?: anti-inflammatory, antioxidant, an- tithrombotic effects
3. How do statins work?: up regulate LDL receptors
4. What are the high intensity statins: atorvastatin rosuvastatin
5. What are the moderate intensity statins: atorvastatin rosuvastatin
simvastatin
6. What are the low intensity statins: simvastatin
7. What is second line option for hyperlipidemia?: ezetimibe
8. How does ezetimibe work?: inhibits cholesterol absorption in small intestine
9. Ezetimbe lowers cholesterol by lowering what?: LDL (18-20%)
10.Ezetimibe is not useful for what: low HDL or high triglycerides
11.What are adverse reactions of ezetimibe?: slight increase in LFT when used with statins, very little risk of
myopathy
12.What is a disadvantage of ezetimibe?: -effects LDL only
-should not be used as monotherapy (use with statin)
-probably does not have the same effect on mortality as statins do
13.What is the indication for PCSK9 inhibitor use?: heterozygous familial hyper- cholesteremia and ASCVD risk
unable to control by statin alone
1/
7
, Management of Cholesterol
Questions and answers
14.What is a PCSK9 inhibitor recommended to take with?: statin
15.What is the PCSK9 inhibitor mechanism of action?: Blocks degradation of LDL receptors on the liver, which
leads to increased clearing of LDL
16.How much can a PCSK9 inhibitor lower LDL?: 45-64%
17.What do we have to monitor when giving PCSK9 medications?: LDL levels
18.What are some adverse effects of PCSK9?: - injection site reactions
- upper respiratory symptoms
- flu like symptoms
19.What are 4 ASCVD statin benefit groups?: 1. Clinical ASCVD
2. LDL >190
3. Diabetes (45-75 yrs) with LDL 70-189
4. LDL 70-189, no diabetes or ASCVD, 10 year risk >7.5%
20.For patients who are very high risk, what needs to be tried prior to starting PCSK9 inhibitor?: maximally
tolerated statin
21.What is the LDL goal for patients at very high risk? What if it is above this number?: <55; reasonable to try
ezetimibe to lower LDL to <55
2/
7
Questions and answers
1. What is the 1st line treatment for hyperlipidemia in all patients without contraindications?: Statin
therapy
2. What roles do statins play in the body?: anti-inflammatory, antioxidant, an- tithrombotic effects
3. How do statins work?: up regulate LDL receptors
4. What are the high intensity statins: atorvastatin rosuvastatin
5. What are the moderate intensity statins: atorvastatin rosuvastatin
simvastatin
6. What are the low intensity statins: simvastatin
7. What is second line option for hyperlipidemia?: ezetimibe
8. How does ezetimibe work?: inhibits cholesterol absorption in small intestine
9. Ezetimbe lowers cholesterol by lowering what?: LDL (18-20%)
10.Ezetimibe is not useful for what: low HDL or high triglycerides
11.What are adverse reactions of ezetimibe?: slight increase in LFT when used with statins, very little risk of
myopathy
12.What is a disadvantage of ezetimibe?: -effects LDL only
-should not be used as monotherapy (use with statin)
-probably does not have the same effect on mortality as statins do
13.What is the indication for PCSK9 inhibitor use?: heterozygous familial hyper- cholesteremia and ASCVD risk
unable to control by statin alone
1/
7
, Management of Cholesterol
Questions and answers
14.What is a PCSK9 inhibitor recommended to take with?: statin
15.What is the PCSK9 inhibitor mechanism of action?: Blocks degradation of LDL receptors on the liver, which
leads to increased clearing of LDL
16.How much can a PCSK9 inhibitor lower LDL?: 45-64%
17.What do we have to monitor when giving PCSK9 medications?: LDL levels
18.What are some adverse effects of PCSK9?: - injection site reactions
- upper respiratory symptoms
- flu like symptoms
19.What are 4 ASCVD statin benefit groups?: 1. Clinical ASCVD
2. LDL >190
3. Diabetes (45-75 yrs) with LDL 70-189
4. LDL 70-189, no diabetes or ASCVD, 10 year risk >7.5%
20.For patients who are very high risk, what needs to be tried prior to starting PCSK9 inhibitor?: maximally
tolerated statin
21.What is the LDL goal for patients at very high risk? What if it is above this number?: <55; reasonable to try
ezetimibe to lower LDL to <55
2/
7
