hyperlipedemia: non-statin tx pt 2

1. PCSK9 inhibitors

1.1. MOA: prevent the protein PCSK9 from binding and degrading liver LDL receptors

1.2. Evolocumab, alirocumab, ezetimibe

1.3. subq injection

1.4. Reserve for those with very high LDL d/t familial hypercholesterolemia or for patients at highest CV risk

1.5. used when patient cannot tolerate statin

1.6. AE: well tolerated; mild local injection site rxns

2. Other non-statin drugs

2.1. ezetimibe

2.1.1. used as an add-on for high risk pts who cannot tolerate a high-intesity statin

2.2. vytorin= zetimibe + simvastatin

2.3. MOA: inhibits intestinal absorption of cholesterol at the brush border

2.4. used alone with diet and in combo with statin

2.5. lower TC, LDL-C

2.6. safeve and effect alone or in combow/statin

2.7. pregnancy c teratogen

3. omega-3 FA

3.1. Lovaza= eicosapentaenoic + docosahexaenoic acid

3.1.1. indicated as an adjunct to diet to decrease triglyceride levels in adults with v high levels

3.2. vascepa= only eicosapentaenoic acid (EPA)

3.2.1. less effective for lowering TGs

4. lifestyle modifications

4.1. exercise regularly

4.2. maintain healthy weight

4.3. avoid tabacco

4.4. DASH diet or mediterranean diet

4.4.1. fruits, veggis, low fat, low dairy, whole grains, limit saturated fat/sodium