you will see a question like this for sure,try to know all detail and differences
109. A 45-year-old male with type II diabetes,
hypertension, and hyperlipidemia presents to
your clinic as a new patient. He has been out of
his cholesterol medications and came to your
office requesting a refill. The patient brought
his most recent lipid profile (done after he was
off his cholesterol medication for 3 months)
which revealed:
Cholesterol (total): 242 mg/dL
HDL cholesterol: 38 mg/dL
Triglycerides (TGs): 660 mg/dL
LDL cholesterol = unable to calculate due
to high TGs
He also had recent liver function tests that were
normal. Based on Adult Treatment Panel (ATP)
III guidelines,
which of the following medications
should be the initial pharmacologic treatment
for this patient?
(A) atorvostatin
(B) gemfibrozil
© cholestyramine
(D) omega-3 fatty acids
(E) nicotinic acid
109. (B) According to the Third Report of the
National Cholesterol Education Program
(NCEP) on the ATP III once the TG levels
are in very high range (greater than 500 mg/dL) the
focus changes from LDL to reducing TGs, as
such high levels can trigger acute pancreatitis.
Once the LDL is lower than 500 mg/dL,
the attention can be turned toward lowering
LDL for CHD reduction. The results of
various recent meta-analyses revealed that
elevated TGs are also an independent risk
factor for CHD. Some factors that may lead
to elevated TG include obesity, physical inactivity,
tobacco use, alcohol use, high carbohydrate
diets, diabetes, chronic kidney
disease, familial disorders, and certain
drugs. ATP III adopts the following classification
for serum TGs:
• Normal TGs: less than 150 mg/dL
• Borderline-high TGs: 150–199 mg/dL
• High TGs: 200–499 mg/dL
• Very high TGs: greater than 500 mg/dL
Nicotinic acid and fibrates have the
largest reduction in TG (25–30% and 35–50%,
respectively) and are thus the first-line recommendations
in addition to diet modification
and exercise in cases of very high TG. Statins
reduce TG by roughly 10–33%, while bile acid
sequestrant can have no effect or even
increase TG levels. Fish oils in high doses can
be used in recalcitrant cases as they may
reduce TG by up to 50%; however GI side
effects are common. It is also important to
note that active omega-3 fatty acids make up
only 30–50% of many fish oil supplements,
whereas Omacor has 90% omega-3 fatty acids.
Although this class of agents can reduce TG
effectively, they have the unwanted effect of
elevating LDL-C levels