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Chapter 5. Dyslipidemia
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HG is a 45-year-old woman who has been diagnosed with dyslipidemia for over a year, she has tried lifestyle modification for 3 months and was started on atorvastatin 40 mg daily about 6 months ago. Her most recent labs indicate low density lipoprotein-cholesterol (LDL-C) of 120 mg/dL. She is reluctant to try another statin as she believes atorvastatin has been working well for her despite a 25% reduction in LDL-C. Which of the following medications would you recommend in addition to continued lifestyle modification for patient HG?
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c. Omega-3-acid ethyl esters
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Answer b is correct. Statins should decrease LDL-C by at least 50%, seeing as there was only a 25% decrease in LDL-C, another agent added would be the most appropriate.
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Answer a is incorrect. It could be added later on if ezetimibe fails in addition to concomitant lifestyle modifications and if the statin is at its maximally tolerated strength.
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Answer c is incorrect. Omega-3-acid ethyl esters are more effective on triglycerides (TGs) than LDL-C.
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Answer d is incorrect. Adding another statin to atorvastatin would not be appropriate.
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HG is a 45-year-old woman who has been diagnosed with dyslipidemia for over a year, she has tried lifestyle modification for 3 months and was started on atorvastatin 40 mg daily about 6 months ago. Her most recent labs indicate low density lipoprotein-cholesterol (LDL-C) of 120 mg/dL. She is reluctant to try another statin as she believes atorvastatin has been working well for her despite a 25% reduction in LDL-C. It is decided that alirocumab 75 mg/mL will be initiated for HG. What of the following criteria is (are) most appropriate for the initiation of alirocumab? Select all that apply.
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a. Adults with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease (ASCVD)
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b. History of myalgias on statin therapy
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c. On a maximum tolerated statin therapy and adjunctive lifestyle modifications
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d. Trial of lifestyle modifications for 3 months
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Answers a and c are correct. Patient needs to have met the criteria listed of familial hypercholesterolemia or clinical ASCVD, on a maximum tolerated statin dose and partake in adjunctive lifestyle modifications.
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Answer b is incorrect. Myalgias can be experienced but is not a reason for criteria to initiate alirocumab, other agents can be tried prior to initiating alirocumab. Another statin could be initiated that was hydrophilic could reduce the likelihood of ...