Causes vascular dx ie stroke, MI, cartoid stenosis, PVD

Rx

• Lifestyule - diet and exercise
• Adherence
• Statins 
• • Indication 
  • • Vascular disease
    • LDL > 190
    • LDL 70-190 + age (40-75ys) + DM/calculated 
  • Dosage:
  • • High intensitiy statins Atovastatin 40-80 or Rosuvastatin 20-40. Recommended.
    • Moderate intensity statins:  Atovastatin 10-20 or Rosuvastatin 5-10: If statin intolerance, age >75 or some comobidity or unsure if should receive statins
• Pre-statin workup: myositis, hepatitis
• • Lipids. Repeat 1yr
  • A1C- no repeat except DM when you should repeat 3mthly
  • CK. No need to repeat if no muscle soreness, weakness, muscle pain: Repeat CK + U/A
  • LFTs. No repeat except hepatitis
• STOP statins if myositis or heaptitis, and go to lower dose ie Moderate intensity statins
• Fibrates are second line. Also increase HDL. Dont use together with statins as it also causes myoisitis and hepatitis
• Others: Niacin also increase HDL but causes flushing hence needs aspirin prophylaxis
• Ezetemibe and Bile acid resins causes Diarrhea