Pandemic Lipid Edition A team-based mission to prevent Cardiovascular outcomes Pandemic

What is the specific statin agent and dose that is still on the market, but not recommended for initiation? Simvastatin 80 mg Due to the increased risk of myopathy, including rhabdomyolysis, use of the 80-mg dose of ZOCOR should be restricted to patients who have been taking simvastatin 80 mg chronically (e.g., for 12 months or more) without evidence of muscle toxicity. (2.2)

List at least two simvastatin drug-drug interactions - including max dose limitations Interacting Agents Simvastatin Recommendations Strong CYP3A4 inhibitors Contraindicated Verapamil, diltiazem, dronedarone 10 mg/day max Amlodipine, amiodarone, ranolazine 20 mg/day max Strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, erythromycin, clarithromycin, telithromycin, HIV protease inhibitors, boceprevir, telaprevir, nefazodone, cobicistat- containing products), gemfibrozil, cyclosporine, danazol

Which statins include grapefruit juice precaution? L A S: Lovastatin, atorvastatin, simvastatin 8 oz of juice or 1 half a grapefruit unlikely to cause an issue – 3A4

List the statins and strengths considered high-intensity Atorvastatin 40 mg, 80 mg Rosuvastatin 20 mg, 40 mg At what age is moderate considered adequate for high risk patients? (age 75)

Meijer Pharmacy offers what statin for free? Atorvastatin 10-80 mg

Which two statins are the least lipophilic ? (hint: most hydrophilic) Pravastatin and rosuvastatin

Which statin is specifically market as being less likely to cause DDI? Pitavastatin (livalo) https://www.livalorx.com

Which omega-3 supplement is marketed to not increase LDL? Vacepa >96% EPA (not associated with  LDL)

Which medication used for TG lowering should be avoid with statins? Gemfibrozil

Which lipid medication is commonly associated with flushing? Niacin

What new class of lipid-lowering medications was recently FDA approved? PCSK9 Inhibitors Praluent (alirocumab) Repatha (evolocumab) PRALUENT (alirocumab) is a PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) inhibitor antibody indicated as adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease, who require additional lowering of LDL-C. The effect of PRALUENT on cardiovascular morbidity and mortality has not been determined.

The Improve-it provided outcomes data with what medication? Vytorin (ezetimibe and simvastatin)

Heart Center of Excellence (bonus points) Name one of the statin + non lipid- lowering medication combos Caduet (amlodipine/atorvastatin) Liptruzet (Ezetimibe/atorvastatin) Juvisync (Sitagliptin/simvastatin)

The race to prevent CV death! Prevention  150 mins of physical activity/week >300 mins of PA/week 2 servings of fish per week Statin 5-10% weight loss BP <140/90

The race to prevent CVD outcomes! Risks  DM Smoker >2400mg of sodium/day BMI >25 Sedentary lifestyle HDL <50 HTN