Mixed Deck — All CLS Topics Flashcards

The mechanism by which evolocumab reduces LDL-C in HeFH patients includes which of the following?

Answer: Binding circulating PCSK9, preventing it from degrading LDL receptors

Evolocumab is a monoclonal antibody that binds PCSK9 in plasma, preventing PCSK9 from binding and targeting LDL receptors for lysosomal degradation, thereby increasing receptor recycling.

What is the Friedewald equation limitation regarding triglycerides when calculating LDL-C?

Answer: It is inaccurate when triglycerides exceed 400 mg/dL

The Friedewald equation (LDL = TC − HDL − TG/5) becomes unreliable when triglycerides exceed 400 mg/dL because the VLDL estimate is inaccurate.

What role does smoking cessation play in cardiovascular risk?

Answer: Reduces cardiovascular risk

Smoking cessation significantly reduces cardiovascular risk by improving endothelial function, decreasing inflammation, and lowering blood pressure and heart rate. Within just a few years of quitting, the risk of heart attack and stroke drops substantially, eventually approaching that of a non-smoker. It is one of the most impactful lifestyle changes for cardiovascular health.

Which fibrate–statin combination carries the greatest risk of severe myopathy and rhabdomyolysis?

Answer: Gemfibrozil + any statin

Gemfibrozil inhibits the glucuronidation pathway responsible for statin metabolism, raising statin plasma concentrations significantly and increasing the risk of myopathy and rhabdomyolysis; fenofibrate does not share this interaction.

Which omega-3 fatty acid formulation is FDA-approved at prescription doses specifically for severe hypertriglyceridemia (≥500 mg/dL)?

Answer: Icosapentaenoic acid (EPA) ethyl esters (Vascepa) and omega-3-acid ethyl esters (Lovaza)

Both Vascepa (pure EPA) and Lovaza (EPA+DHA) are FDA-approved prescription omega-3 formulations for triglycerides ≥500 mg/dL.

Anorexia nervosa is associated with which lipid pattern?

Answer: Elevated total cholesterol and LDL-C with reduced bile acid excretion

Anorexia nervosa often paradoxically raises LDL-C and total cholesterol due to reduced bile acid production, decreased LDL receptor activity, and impaired reverse cholesterol transport.

Which statement most accurately describes the cardiovascular outcomes data available for bempedoic acid?

Answer: CLEAR Outcomes trial showed 13% reduction in major adverse cardiovascular events vs. placebo in statin-intolerant patients

The CLEAR Outcomes trial demonstrated that bempedoic acid reduced MACE by approximately 13% versus placebo in statin-intolerant patients with or at high risk for ASCVD.

What does HDL cholesterol help with?

Answer: Cholesterol removal

HDL cholesterol plays a crucial role in reverse cholesterol transport, which is the process of cholesterol removal. It picks up excess cholesterol from cells and arterial walls and transports it back to the liver for processing and excretion. This helps prevent the buildup of plaque and protects against cardiovascular disease.

What is the primary function of lipids in the body?

Answer: They store energy and form membranes

Lipids are a diverse group of organic compounds essential for various biological functions. Their primary roles include long-term energy storage, as they are highly efficient at storing metabolic energy. Additionally, phospholipids are the fundamental building blocks of cell membranes, forming the lipid bilayer that defines cellular boundaries and regulates substance passage.

A CLS is reviewing a lipid panel in a patient taking niacin. Which expected lipid change is most characteristic of niacin therapy?

Answer: Marked increase in HDL-C and reduction in both TG and LDL-C

Niacin has the broadest lipid effect profile: it raises HDL-C most significantly (15–35%), reduces TG (20–50%), and modestly reduces LDL-C (5–25%), making it unique among lipid-modifying agents.

Which statin is the most hydrophilic and is least likely to cause CNS side effects such as sleep disturbances?

Answer: Rosuvastatin

Rosuvastatin is the most hydrophilic statin, which limits its CNS penetration and is associated with fewer CNS-related adverse effects.

When is a non-fasting lipid panel preferred over a fasting panel for cardiovascular risk assessment?

Answer: For initial screening and routine risk assessment in most adults

Current ACC/AHA and ESC guidelines support non-fasting lipid measurement for routine cardiovascular risk screening, as non-fasting LDL-C correlates well with ASCVD risk.

Growth hormone deficiency in adults is associated with which lipid pattern?

Answer: Elevated LDL-C, elevated triglycerides, and low HDL-C

Adult GH deficiency promotes visceral adiposity and insulin resistance, causing a pro-atherogenic lipid profile with elevated LDL-C, elevated TG, and low HDL-C.

Which medication class is used as an adjunct to statins in children with familial hypercholesterolemia who need additional LDL-C lowering?

Answer: Bile acid sequestrants

Bile acid sequestrants (e.g., colesevelam) are approved for pediatric use and provide additive LDL-C lowering with statins.

A CLS is counseling a patient about statin-associated muscle symptoms (SAMS). Which statin-related factor increases the risk of myopathy?

Answer: High-dose statin therapy

Higher statin doses are associated with significantly greater risk of SAMS and rhabdomyolysis due to elevated drug exposure.

In patients with type 2 diabetes mellitus, which lipid abnormality is MOST characteristic?

Answer: Elevated triglycerides, low HDL-C, and small dense LDL particles

T2DM classically produces the 'diabetic dyslipidemia' triad: elevated triglycerides, low HDL-C, and a predominance of small dense LDL particles.

Which statement about FH and secondary prevention is correct?

Answer: FH patients with ASCVD are very-high-risk and should target LDL-C 50% reduction

FH patients with established ASCVD fall into the very-high-risk category per ACC/AHA guidelines, warranting an LDL-C goal of <55 mg/dL and at least 50% reduction from baseline.

In a patient who has experienced verified statin-induced myopathy with one statin, the most evidence-based rechallenging strategy is:

Answer: Switch to a different statin at the lowest available dose after CK normalization and muscle symptom resolution

Guidelines recommend rechallenging with a different statin (preferably one with lower myopathy risk such as rosuvastatin, pravastatin, or fluvastatin) at the lowest available dose after symptoms and CK normalize.

What is the primary mechanism of action of fibrates?

Answer: Activate peroxisome proliferator-activated receptor alpha (PPARα)

Fibrates activate PPARα, a nuclear receptor that increases lipoprotein lipase expression, reduces apoC-III production, and increases apoA-I synthesis, resulting in reduced triglycerides and increased HDL-C.

In the context of metabolic syndrome, which pattern of lipoprotein abnormality is most characteristic?

Answer: Low HDL-C, elevated triglycerides, and small dense LDL particles

Metabolic syndrome is associated with an atherogenic dyslipidemia triad: elevated triglycerides, low HDL-C, and increased small dense LDL particles, driven by insulin resistance and excess hepatic VLDL production.