Statins
Think "LOWER IS BETTER" for LDL in high CV risk patients
As a cardiovascular pharmacist, there is an ongoing debate regarding the necessity of aiming for a specific LDL goal. For over a decade, the focus has been on using target DOSES of statins shown to reduce CV risk , rather than titrating to an LDL goal. But there’s been a shift toward a blended approach in recent years. Data comparing specific LDL targets are limited.…
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Statins
Coenzyme Q10 for STATIN intolerance
As a community pharmacist, patients will ask you more about Coenzyme Q10 for STATIN intolerance. Statin intolerance is present in about 9% of statin-treated patients, according to a recent meta-analysis. This finding is getting a lot of attention and is likely to increase interest in supplements that might help limit statin-induced muscle pain and weakness . Be prepa…
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Statins
Are Fish Oil supplements safe?!
As a nutrition support pharmacist, patients are asking whether fish oil supplements are safe. Some fish contain contaminants like mercury, PCBs, or dioxins. But most fish oil supplements are mercury-free since mercury accumulates in the meat more than the oils. And a large amount of other toxins are removed during manufacturing. But to be safe, direct patients to pro…
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Statins
Be aware of the role of STATINS in children
As a clinical pharmacist, you should be familiar with the Role of statins in children. More children will be screened and treated for dyslipidemia, now that Canadian and american guidelines suggest expanded screening. About 1 in 300 children are born with familial hypercholesterolemia (FH), which can lead to heart disease , stroke , and early death in adulthood if n…
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Statins
Approach to STATIN intolerance
As a pharmacist, you should know how to deal with statin muscle pain . Mounting evidence suggests that statin-associated muscle pain is driven by a patient’s expectation of harm. In fact, statin-intolerant patients often rate muscle symptoms similarly with statin OR placebo. But it’s still how they feel, often leading to poor adherence. Consider this approach for pat…
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Statins
Focus on DIET and exercise for high triglycerides
As a nutrition pharmacy specialist, you will see more focus on diet and exercise for high triglycerides and less reliance on prescribed (Rx) medications. This is different from current practice... Fenofibrate ( Lipanthyl, Fenolip, etc) use is increasing, despite the fact that there's no proof it improves cardiovascular outcomes. Regu…
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Type-2 Diabetes
Ensure your DIABETIC patients are on statin
Many eligible adults with diabetes aren’t on a statin . We know that statins reduce cardiovascular (CV) risk in patients with type 1 or 2 diabetes , and guidelines recommend use. Plus statin use in patients with diabetes age 40 to 75 is a common quality measure. Follow these steps... Think of statins as "automatic" for most …
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TIA
Start with HIGH-dose atorvastatin after stroke
New evidence will spark questions about whether to aim for an LDL goal in patients with a prior ischemic stroke or TIA . For several years, we’ve been using target DOSES of statins shown to reduce cardiovascular (CV) risk rather than titrating to an LDL goal. Now data suggest treating to an LDL below 70 mg/dL instead of about 95 mg/dL prevents a re…
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Statins
Evaluate the need for NON-statins
As a hospital pharmacist, you will continue to see LESS use of non-statins (niacin, etc) for dyslipidemia due to limited evidence of CV benefit. Consider discontinuing non-statins when patients are admitted if there's no good reason for the patient to be on them. Use these tips to evaluate the need for non-statins... Save non-stati…
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Statins
Ensure peri-op CABG medication regimens are optimized
As a hospital pharmacist, you'll see more focus on medication choices after coronary artery bypass graft (CABG) surgery to improve care and reduce hospital readmissions. Follow the new American Heart Association (AHA) recommendations to ensure peri-operative CABG medication regimens are optimized and help prevent readmissions... Asp…
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Statins
How to manage HYPERtriglyceridemia
Questions will come up about how to manage high triglycerides, due to recent guidance from the American College of Cardiology . We know that a fasting triglyceride level of 150 mg/dL or higher is a marker for cardiovascular (CV) disease. But using medications specifically to lower triglycerides isn’t proven to reduce CV events or to prevent pancreatitis, even in pati…
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Statins
How to handle statin muscle pain?
As a pharmacist, you may know that up to 30% of statin patients get muscle pain, cramps, or weakness, usually in the larger muscles such as the thighs. You should suggest these strategies to help patients stay on the statin... Lowering the dose is often enough to reduce symptoms. Changing the statin to fluvastatin, pravastatin, or …
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Statins
Statins may be okay to use in pregnant patients
You will hear controversy about whether statins are okay to use in pregnant patients. This is coming up because labelling for statins in the U.S. will no longer say they're contraindicated during pregnancy . Experts now say statin benefits may outweigh risks in the very small group of pregnant patients at very high CV risk. This includes pregnant patients with ho…
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Statins
How to deal with statin interaction?
Statin INRERACTION alerts continue to cause confusion. We know to watch for the more problematic statins: simvastatin, lovastatin, or atorvastatin since they're metabolized by CYP3A4 the most. But be familiar with some of the less cut-and-dried interactions... Are all azole antifungals a big problem? No. Fl…
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Statins
When should statins be prescribed for patients younger than 40 years old?
When should statins be used in adults under age 40? ― Statins clearly improve outcomes regardless of age in patients with a prior heart attack or stroke for SECONDARY prevention or in familial hypercholesterolemia with an LDL of 190 mg/dL or higher. But for others under 40, this is a gray area (there's no evidence). Don't jump …
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Statins
Optimization of lipids in CARDIOvascular patients
Focus on statin dose statin dose instead of LDL levels. It's not about aiming for LDL goals anymore. The new thinking is that it's more important to get patients on a statin dose proven to lower cardiovascular risk than to get LDL to a certain number. Use these common scenarios when helping your patients... How should patients…
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Statins
Pharmacology of HMG-CoA inhibitors (Statins)
Therapeutic actions ㅡ HMG-CoA inhibitors are antihyperlipidemic. They are a fungal metabolite that inhibits the enzyme that catalyzes the first step in the cholesterol synthesis pathway in humans, resulting in a decrease in serum cholesterol and serum LDLs (associated with increased risk of CAD); either an increase or no change in serum HDLs (associated with decreas…
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