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Chapter 5. Dyslipidemia

CX is a 62-year-old patient that presents to your pharmacy seeking guidance on an appropriate diet to reduce heart disease risk in a patient with high cholesterol. Which of the following lifestyle changes should be recommended to patients with dyslipidemia?

a. Increase intake of animal products and low carbohydrate vegetables, and limit grains and fruit

b. Reduce trans fat and limit saturated fat to <10% of calories

c. Engage in regular physical activity

d. Eat one serving per week of fatty fish

Answer c is correct. Increased activity is important for all patients without physical restrictions. AHA/ACC lifestyle management guidelines endorse three to four sessions a week of moderate to vigorous intensity physical activity with an average duration of 40 minutes per session.

Answers a, b, and d are incorrect. The AHA/ACC lifestyle management guidelines advise eating a diet rich in vegetables, fruits, and whole grains, including low-fat dairy products, fish, poultry, legumes, and nuts, with limited intake of saturated fat, trans fat, sweets, sugar-sweetened beverages, and red meats. Dietary adaptations are available for vegetarians or vegans. Although trans fat should be reduced or preferably eliminated, the favored saturated fat intake is also just 5% to 6% of calories. The AHA recommends consuming at least two servings of fish per week for the general population and approximately 1 g of EPA + DHA daily (preferably from oily fish) for those with documented CHD.

MM is a 54-year-old woman with a past medical history of unstable angina, hypertension, and diabetes. She smokes two packs of cigarettes daily. Her LDL-C is 120 mg/dL, HDL-C 48 mg/dL, and TG 220 mg/dL. Which of the following therapy is recommended?

a. Simvastatin 80 mg daily

b. Atorvastatin 80 mg daily

c. Pravastatin 20 mg daily

d. Lovastatin 40 mg daily

Answer b is correct. Because MM has clinical ASCVD, the ACC/AHA expert panel recommends high-intensity statin, lowering LDL-C ≥50% (ie, atorvastatin 40 mg and 80 mg or rosuvastatin 20 mg and 40 mg daily). The 80 mg atorvastatin and 20 mg rosuvastatin doses are preferred and best supported by randomized clinical trials.

Answer a is incorrect. Patients should not be started on or titrated to simvastatin 80 mg due to increased risk of rhabdomyolysis.

Answer c is incorrect. Pravastatin 20 mg is a low-intensity statin therapy, lowering LDL-C <30%.

Answer d is incorrect. Lovastatin 40 mg is a moderate-intensity therapy, lowering LDL-C 30 to ...

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