Hyperlipidemia (Advanced Pharmacology)
HTN and hyperlipidemia are two of the most common issues in primary care. Children, adults, and elders are all affected and the prevalence of these disorders seems to be increasing. This week think about:
1). What is the medication of choice for a 35 year old female with significant hyperlipidemia and a significant FH CAD (two siblings had MIs in their 30’s).
2). What medication could be used for a child with hyperlipidemia?
3). Should an elderly person be continued on a statin drug forever?
According to (Mulders et al., 2017), a daily regimen including vitamins C. and E, with atorvastatin 20 mg in individuals with a significant family history of coronary artery disease at an early onset demonstrated a remarkable reduction in the rate of acquired coronary artery disease (p. 257)
The current recommendation for children is to place an emphasis on diet and lifestyle changes not just for the child, but for the family as well (O’Gorman, O’Neill, & Conwell, 2011, p. 5). Patients with a significant family history of coronary artery disease and a low- density lipoprotein (LDL) of greater than or equal to 160 mmol/l or LDL greater than or equal to 190 mmol/l can be started on statins in conjunction with diet and lifestyle modification (O’Gorman et al., 2011, pp. 8,9).
In my experiences in managing hyperlipidemia in adolescents, it is critical to emphasize the importance of maintaining a healthy lifestyle in terms that they can relate to. They are generally less receptive to prevention of health concerns like CAD that could occur later in life. Focusing on maintaining a healthy lifestyle of diet and exercise in relation to improved physical performance, mood stability, and a healthier appearance, are aspects that are of more immediate concern to this age group. It is also important when considering a statin, to emphasize that taking a cholesterol-lowering drug is not a license to engage in poor eating habits in the false assumption that the medication will make them impervious to the effects of eating unhealthy food.
(Edmunds, Mayhew, & Setter, 2013, p. 300) recommends that children who are taking statins should be managed by a specialist (p.300). The majority of our patients are on Medicaid. Medicaid requires that simvastatin is the drug used for initiating therapy. The basic tenants of prescribing should be followed with considerations to cost, effectiveness and lowest potential for adverse effects. The rationale of treatment must also be considered with the goal of short-term therapy logically being a primary goal.
According to (Edmunds et al., 2013) states that “no data are available on patients older than 75, and lipid-lowering therapy is controversial” (p. 300). It is important to always assess the risk against the benefits when considering therapy at any age. Some of the adverse effects of statins can include confusion, amnesia, muscle aches, liver dysfunction, and potentially diabetes (p. 301). These are all serious considerations in the geriatric population due to the potential for comorbidities such as falls, and damage to organs that already may demonstrate a diminishing function. (LaRosa, 2014) state that many of the side effects of statins can be addressed and prevention of stroke and CAD should be a high concern.
Edmunds, M. W., Mayhew, M. S., & Setter, S. M. (2013). Pharmacology for the primary care provider (Fourth edition. ed.). St. Louis, Missouri: Elsevier Mosby.
LaRosa, J. C. (2014). Treatment of cholesterol in the elderly: statins and beyond. Curr Atheroscler Rep, 16(2), 385. doi: 10.1007/s11883-013-0385-x
Mulders, T. A., Sivapalaratnam, S., Stroes, E. S., Kastelein, J. J., Guerci, A. D., & Pinto-Sietsma, S. J. (2012). Asymptomatic individuals with a positive family history for premature coronary artery disease and elevated coronary calcium scores benefit from statin treatment: a post hoc analysis from the St. Francis Heart Study. JACC Cardiovasc Imaging, 5(3), 252-260. doi: 10.1016/j.jcmg.2011.11.014
O’Gorman, C. S., O’Neill, M. B., & Conwell, L. S. (2016). Considering statins for cholesterol-reduction in children if lifestyle and diet changes do not improve their health: a review of the risks and benefits. Vasc Health Risk Manag, 7, 1-14. doi: 10.2147/VHRM.S7356