and exercise are targets of therapy through lifestyle modifications. Nonmodifiable risk factors include age, gender, race, and family history. Both categories of risk factors are part of the calculation of overall risk for CVD. Table 39-2 presents the major risk factors for CVD exclusive of the serum LDL. Five factors are considered contributory to low risk and negative risk for CVD: not smoking, normal BP, normal weight, normal glucose metabolism, and low cholesterol levels. Look to figure: 39-2 Positive RISK (CHD): Age: Male: ≥45; Female: ≥55 Family history: Premature CHD (MI or sudden death before 55 yr in father or other male first-degree relative or before 65 yr in mother or female first-degree relative) Cigarette smoking: Current smoking (any cigarette smoking in past month) Hypertension: BP ≥140/90 mm Hg or on antihypertensive medication HDL cholesterol: HDL ≤40 mg/dL Diabetes mellitus: Presence, especially if poorly controlled Powerpoint Drug therapies for Hyperlipidemia: ▪ HMG CoA reductase inhibitors ▪ Lovast atin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin ▪ Fibrat es: fibric acid derivatives ▪ Gemfi brozil, micronized fenofibrate, clofibrate
81 ▪ Bile acid sequestrants ▪ Chole styramine, colestipol, colesevelam ▪ Niaci n (has lost its luster) ▪ Ezeti mibe ( Zetia ): most effective in combination with statin ▪ Vitam ins/antioxidants/herbs/natural products ▪ Vitam in E, C, folic acid, garlic, fish oils, fiber, coenzyme Q10, flaxseed ▪ * Acti ve liver disease is a contraindication for all except the bile acid sequestrants. 48.Thiazide diuretics The thiazide-type diuretics act on the distal renal tubule to inhibit sodium reabsorption. Their effect is generally longer-lasting, and they cause less brisk diuresis. Diuretics are still considered first-line therapy for HTN with the JNC-8. Thiazide diuretics are the most commonly prescribed agents for HTN. Higher doses of these drugs can cause modest and often transient increases in serum LDL cholesterol and TG, with little or no adverse effects on HDL cholesterol. Electrolyte imbalances are common in all diuretic classes. Thiazide and loop diuretics cause hypokalemia and may cause hypercalcemia, hyponatremia, and hypomagnesemia. Several thiazide and loop diuretics are Pregnancy Category C and should be used only when benefits clearly outweigh risks. Thiazide and loop diuretics decrease the renal excretion of lithium and may induce lithium toxicity. These two classes may decrease the action of sulfonylureas and insulin. Thiazide diuretics and spironolactone diminish the anticoagulant effects of warfarin.
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