Therapeutic Lifestyle & Pharmacologic Interventions Flashcards

A patient with heterozygous familial hypercholesterolemia (HeFH) on maximally tolerated statin plus ezetimibe has LDL-C of 140 mg/dL. The most appropriate next step is:

Answer: Add a PCSK9 inhibitor

Guidelines recommend PCSK9 inhibitors as the preferred add-on therapy for FH patients who remain above LDL-C goals on statin plus ezetimibe.

The Mediterranean diet reduces cardiovascular risk primarily by emphasizing which dietary pattern?

Answer: Olive oil, fish, vegetables, legumes, and moderate red wine

The Mediterranean diet emphasizes olive oil, fatty fish, vegetables, legumes, whole grains, nuts, and moderate wine, reducing cardiovascular events as shown in PREDIMED.

Which drug interaction requires dose reduction of simvastatin to no more than 10 mg/day due to markedly increased exposure risk?

Answer: Amiodarone

Amiodarone inhibits CYP3A4 and P-glycoprotein, significantly increasing simvastatin exposure; the FDA recommends a maximum simvastatin dose of 10 mg with amiodarone.

Lomitapide (Juxtapid) is approved for homozygous familial hypercholesterolemia (HoFH). It reduces LDL-C by inhibiting which protein?

Answer: Microsomal triglyceride transfer protein (MTP)

Lomitapide inhibits microsomal triglyceride transfer protein (MTP), blocking hepatic assembly and secretion of apoB-containing lipoproteins including VLDL and LDL.

What is the primary mechanism by which fibrates (fenofibrate, gemfibrozil) lower triglyceride levels?

Answer: Activating PPAR-alpha to increase lipoprotein lipase activity and reduce apoC-III

Fibrates activate PPAR-alpha, increasing lipoprotein lipase (LPL) activity and reducing apoC-III (an LPL inhibitor), thereby enhancing TG-rich lipoprotein clearance.

A patient wants to know if eating walnuts and almonds will worsen their lipids. The CLS should counsel that tree nuts primarily have which effect on the lipid panel?

Answer: Modestly lower LDL-C and improve LDL/HDL ratio

Tree nuts are rich in PUFAs and MUFAs, fiber, and plant sterols, consistently lowering LDL-C by 3-19% and improving the LDL/HDL ratio in meta-analyses.

Mipomersen (Kynamro), an antisense oligonucleotide used in HoFH, reduces LDL-C by targeting:

Answer: ApoB-100 mRNA

Mipomersen is an antisense oligonucleotide that targets apoB-100 mRNA, reducing hepatic synthesis of apoB and all apoB-containing lipoproteins (VLDL, IDL, LDL).